Provider Demographics
NPI:1356331037
Name:EMORY, ROGER E (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:E
Last Name:EMORY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 ABINGDON PL
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24211-5197
Mailing Address - Country:US
Mailing Address - Phone:276-623-4500
Mailing Address - Fax:276-623-4510
Practice Address - Street 1:112 ABINGDON PL
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24211-5197
Practice Address - Country:US
Practice Address - Phone:276-623-4500
Practice Address - Fax:276-623-4510
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01018404542086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
427211OtherCOMBINED INSURANCE
VA451661OtherANTHEM
541959466-01OtherJOHN DEERE
VA6900283Medicaid
VA6900283Medicaid