Provider Demographics
NPI:1669568044
Name:VIRGIN, TONY (MD)
Entity type:Individual
Prefix:
First Name:TONY
Middle Name:
Last Name:VIRGIN
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 1595
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-1595
Mailing Address - Country:US
Mailing Address - Phone:606-408-4000
Mailing Address - Fax:606-408-3611
Practice Address - Street 1:912 PARK AVE
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-1596
Practice Address - Country:US
Practice Address - Phone:740-534-0021
Practice Address - Fax:740-534-0029
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-080020207Q00000X
KY37987207Q00000X
OH15995122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00000193OtherRR MEDICARE
KY64061609Medicaid
OH0397806Medicaid
OH2274257Medicaid
WV0137181002Medicaid
OHP00000193OtherRR MEDICARE
OH0397806Medicaid
OH2274257Medicare PIN
OH2274257Medicaid
OHP00000193Medicare PIN
H50896Medicare UPIN
WV0137181002Medicaid
OH4061867Medicare PIN
KY0586614Medicare PIN
KY0351442Medicare PIN
KY64061609Medicaid
OH4061866Medicare PIN
KY307643Medicare PIN