Provider Demographics
NPI:1447250501
Name:VIRGILIO, LAWRENCE A (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:A
Last Name:VIRGILIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 56
Mailing Address - Street 2:
Mailing Address - City:CAPE MAY COURT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210-0056
Mailing Address - Country:US
Mailing Address - Phone:609-463-2000
Mailing Address - Fax:
Practice Address - Street 1:2 STONE HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-2138
Practice Address - Country:US
Practice Address - Phone:609-463-2755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05982200207ZC0500X, 207ZP0102X, 207ZI0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
No207ZI0100XAllopathic & Osteopathic PhysiciansPathologyImmunopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5625203Medicaid
NJ640316Medicare PIN