Provider Demographics
NPI:1356447759
Name:PONFERRADA, VIRGILIO ARPON (MD)
Entity Type:Individual
Prefix:DR
First Name:VIRGILIO
Middle Name:ARPON
Last Name:PONFERRADA
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:PO BOX 1719
Mailing Address - Street 2:
Mailing Address - City:PIQUA
Mailing Address - State:OH
Mailing Address - Zip Code:45356
Mailing Address - Country:US
Mailing Address - Phone:937-773-7083
Mailing Address - Fax:937-773-9716
Practice Address - Street 1:9163 NORTH COUNTY ROAD
Practice Address - Street 2:25-A
Practice Address - City:PIQUA
Practice Address - State:OH
Practice Address - Zip Code:45356
Practice Address - Country:US
Practice Address - Phone:937-773-7083
Practice Address - Fax:937-773-9716
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH037425208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0288424Medicaid
OH0288424Medicaid
OHA75057Medicare UPIN