MEDICARE: DR. VIRGILIO MILLADO TONGSON MD

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	174400000X	Specialist	35053410	OH

General Provider Information

NPI Number	:	1518957331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIRGILIO MILLADO TONGSON MD

Provider Business Mailing Address
First Line	:	31 E MAIN ST
Second Line	:	STE 4
City	:	SHELBY
State	:	OH
Zip	:	44875-1262
Country	:	US
Telephone Number	:	419-347-8442
Fax Number	:	419-347-2210

Provider Business Practice Location Address
First Line	:	31 E MAIN ST
Second Line	:	STE 4
City	:	SHELBY
State	:	OH
Zip	:	44875-1262
Country	:	US
Telephone Number	:	419-347-8442
Fax Number	:	419-347-2210

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

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	01/09/2020

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