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General NPI Number Information
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NPI Number | 1700821907
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Entity Type | Individual
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Provider Name | RICARDO A ROA MD
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Gender | Male
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 02/09/2015
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Provider Practice Location Address
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Address Line | 96 TOWNSHIP ROAD 369 STE 101
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City | PROCTORVILLE
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State | OH
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Zip | 45669-9133
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Country | US
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Telephone | 740-886-9370
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Fax | 740-886-9374
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Provider Business Mailing Address
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Address Line | 90 JACKSON PIKE
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City | GALLIPOLIS
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State | OH
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Zip | 45631
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Country | US
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Telephone | 740-886-9370
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Fax | 740-886-9374
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 17624
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 35-07-8877-R
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License Number State | OH
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