Basic Information
| Provider Information | |||||||||
| NPI: | 1447250501 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VIRGILIO | ||||||||
| FirstName: | LAWRENCE | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 56 | ||||||||
| Address2: | |||||||||
| City: | CAPE MAY COURT HOUSE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082100056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6094632000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2 STONE HARBOR BLVD | ||||||||
| Address2: | |||||||||
| City: | CAPE MAY COURT HOUSE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082102138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6094632755 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2005 | ||||||||
| LastUpdateDate: | 10/23/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZC0500X | 25MA05982200 | NJ | N | Allopathic & Osteopathic Physicians | Pathology | Cytopathology | 207ZP0102X | 25MA05982200 | NJ | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 207ZI0100X | 25MA05982200 | NJ | N | Allopathic & Osteopathic Physicians | Pathology | Immunopathology |
ID Information
| ID | Type | State | Issuer | Description | 5625203 | 05 | NJ | MEDICAID |