Provider Demographics
NPI:1083694723
Name:WARD, ROGER (DO)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:WARD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2951 MAPLE AVE
Mailing Address - Street 2:MOB II GARDEN LEVEL - CVO
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-2861
Mailing Address - Country:US
Mailing Address - Phone:740-450-6147
Mailing Address - Fax:740-450-6157
Practice Address - Street 1:2800 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-1716
Practice Address - Country:US
Practice Address - Phone:740-454-4585
Practice Address - Fax:740-454-4008
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-008449207P00000X
OH34.008449207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2627081Medicaid
4180983Medicare PIN
OH2627081Medicaid
4180984Medicare PIN