MEDICARE: DOUGLAS J VIROSTKO 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	207Q00000X	Family Medicine Physician	35062459	OH

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	:	1538164868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS J VIROSTKO MD

Provider Business Mailing Address
First Line	:	409 S 4TH ST
Second Line	:
City	:	COSHOCTON
State	:	OH
Zip	:	43812-2024
Country	:	US
Telephone Number	:	740-622-0332
Fax Number	:	740-622-0335

Provider Business Practice Location Address
First Line	:	440 BROWNS LN
Second Line	:
City	:	COSHOCTON
State	:	OH
Zip	:	43812-2044
Country	:	US
Telephone Number	:	740-622-0332
Fax Number	:	740-622-0335

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

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	08/08/2013

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