MEDICARE: ROGER ISLA 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	207Y00000X	Otolaryngology Physician	35035903I	OH
2	207Y00000X	Otolaryngology Physician	10220	WV

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265439301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROGER ISLA M.D.

Provider Business Mailing Address
First Line	:	651 COLLIERS WAY
Second Line	:	SUITE 203
City	:	WEIRTON
State	:	WV
Zip	:	26062-5053
Country	:	US
Telephone Number	:	304-723-6040
Fax Number	:	304-723-6039

Provider Business Practice Location Address
First Line	:	651 COLLIERS WAY
Second Line	:	SUITE 408
City	:	WEIRTON
State	:	WV
Zip	:	26062-5053
Country	:	US
Telephone Number	:	304-723-0005
Fax Number	:	304-723-0074

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

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	08/09/2013

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Directions to “ ROGER ISLA M.D.” Practice Location

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