Healthcare Provider Details

I. General information

NPI: 1053499079
Provider Name (Legal Business Name): ROGER WINGER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 DELAWARE AVE SUITE 101
MARION OH
43302-6475
US

IV. Provider business mailing address

301 FRANKLIN ST
MARION OH
43302-4019
US

V. Phone/Fax

Practice location:
  • Phone: 740-383-2513
  • Fax: 740-387-6495
Mailing address:
  • Phone: 740-387-5572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberA-00072
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: