Healthcare Provider Details

I. General information

NPI: 1235245341
Provider Name (Legal Business Name): JORGE W ROIG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 COLLIERS WAY STE 510
WEIRTON WV
26062-5054
US

IV. Provider business mailing address

109 MOUNT WOOD RD
WHEELING WV
26003-2632
US

V. Phone/Fax

Practice location:
  • Phone: 304-797-6595
  • Fax: 304-797-6052
Mailing address:
  • Phone: 304-233-2455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35-079250
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number20028
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: