MEDICARE: AGNES VIRGA M. D.

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	204C00000X	Sports Medicine (Neuromusculoskeletal Medicine) Physician	80633	MA

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

General Provider Information

NPI Number	:	1184614414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AGNES VIRGA M. D.

Provider Business Mailing Address
First Line	:	411 MASS AVE
Second Line	:
City	:	ACTON
State	:	MA
Zip	:	01720-3739
Country	:	US
Telephone Number	:	978-263-2898
Fax Number	:	978-263-3305

Provider Business Practice Location Address
First Line	:	411 MASS AVE
Second Line	:
City	:	ACTON
State	:	MA
Zip	:	01720-3739
Country	:	US
Telephone Number	:	978-263-2898
Fax Number	:	978-263-3305

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

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	07/08/2007

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Directions to “ AGNES VIRGA M. D.” Practice Location

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