Provider Demographics
NPI:1760447304
Name:VIRGILE, ROGER S (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:S
Last Name:VIRGILE
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 1:312 13TH ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:PA
Mailing Address - Zip Code:16323-1335
Mailing Address - Country:US
Mailing Address - Phone:814-437-2444
Mailing Address - Fax:814-432-7077
Practice Address - Street 1:312 13TH ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:PA
Practice Address - Zip Code:16323-1335
Practice Address - Country:US
Practice Address - Phone:814-437-2444
Practice Address - Fax:814-432-7077
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044486L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014838970003Medicaid
PA0014838970003Medicaid
PAE85120Medicare UPIN