Provider Demographics
NPI:1336187095
Name:CARRICO, VIRGIL N (MD)
Entity Type:Individual
Prefix:
First Name:VIRGIL
Middle Name:N
Last Name:CARRICO
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 1:442 W HIGH ST
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:OH
Mailing Address - Zip Code:43506-1681
Mailing Address - Country:US
Mailing Address - Phone:419-636-4517
Mailing Address - Fax:419-636-6438
Practice Address - Street 1:222 W JACKSON STREET
Practice Address - Street 2:
Practice Address - City:WEST UNITY
Practice Address - State:OH
Practice Address - Zip Code:43570
Practice Address - Country:US
Practice Address - Phone:419-924-2341
Practice Address - Fax:419-924-5374
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35033003207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH080042253OtherRAILROAD
OH0204648Medicaid
OH0204648Medicaid