Provider Demographics
NPI:1205877933
Name:LAWRENCE A VIRGILIO, MD, PA
Entity type:Organization
Organization Name:LAWRENCE A VIRGILIO, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:VIRGILIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-463-2448
Mailing Address - Street 1:PO BOX 56
Mailing Address - Street 2:
Mailing Address - City:CAPE MAY COURT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210-0056
Mailing Address - Country:US
Mailing Address - Phone:609-463-2448
Mailing Address - Fax:
Practice Address - Street 1:2 STONE HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-2138
Practice Address - Country:US
Practice Address - Phone:609-463-2448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA05982200207ZP0102X, 207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Multi-Specialty
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5625203Medicaid
NJ5625203Medicaid
NJ640316Medicare PIN