Provider Demographics
NPI:1841255122
Name:VIRATA, ANDREW R (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:R
Last Name:VIRATA
Suffix:
Gender:
Credentials:MD
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Mailing Address - Street 1:2720 FAIRVIEW AVE N STE 200
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-1306
Mailing Address - Country:US
Mailing Address - Phone:651-633-6883
Mailing Address - Fax:651-331-3459
Practice Address - Street 1:2651 HILLCREST DR STE 304
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-9914
Practice Address - Country:US
Practice Address - Phone:651-633-6883
Practice Address - Fax:651-331-3459
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN55820207ZD0900X, 207ZP0102X, 207ZP0105X
WI48559207ZD0900X, 207ZP0105X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35341900Medicaid
WI0628 20195Medicare PIN