MEDICARE: ROBERT CONIGLIO PA

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	363A00000X	Physician Assistant	0110000090	VA

General Provider Information

NPI Number	:	1336127554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT CONIGLIO PA

Provider Business Mailing Address
First Line	:	20280 MARKET ST
Second Line	:
City	:	ONANCOCK
State	:	VA
Zip	:	23417-1331
Country	:	US
Telephone Number	:	757-414-0400
Fax Number	:	757-414-0569

Provider Business Practice Location Address
First Line	:	4049 MAIN ST
Second Line	:
City	:	CHINCOTEAGUE ISLAND
State	:	VA
Zip	:	23336-2406
Country	:	US
Telephone Number	:	757-336-3682
Fax Number	:	757-336-3703

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

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	06/02/2020

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