Organization
UPPER MIAMI VALLEY UROLOGY CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VIRGILIO A. PONFERRADA M.D. (PRESIDENT)
(937) 773-7083
Entity
Organization
Contact information
Practice address
9163 N COUNTY ROAD 25A, PIQUA, OH 45356-4524
(937) 773-7083
(937) 773-9716
Mailing address
PO BOX 1719, PIQUA, OH 45356-4719
(937) 773-7083
(937) 773-9716
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
037425
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0746803
—
OH
Enumeration date
05/07/2008
Last updated
05/07/2008
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