MEDICARE: RICARDO A ROA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	17624	WV
2	207Y00000X	Otolaryngology Physician	35-07-8877-R	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00420122	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1044883	OTHER	WV	BWC
4	1700821907	OTHER	OH	MOUTAIN STATE BC/BS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700821907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICARDO A ROA MD

Provider Business Mailing Address
First Line	:	1611 27TH ST
Second Line	:
City	:	PORTSMOUTH
State	:	OH
Zip	:	45662-6931
Country	:	US
Telephone Number	:	740-356-6836
Fax Number	:	740-356-6806

Provider Business Practice Location Address
First Line	:	1611 27TH ST
Second Line	:
City	:	PORTSMOUTH
State	:	OH
Zip	:	45662-6931
Country	:	US
Telephone Number	:	740-356-6836
Fax Number	:	740-356-6806

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	04/22/2026

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Directions to “ RICARDO A ROA MD” Practice Location

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