Provider Demographics
NPI:1386622728
Name:ESPINOSA, ROGER G (MD)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:G
Last Name:ESPINOSA
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 983
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44061-0983
Mailing Address - Country:US
Mailing Address - Phone:440-354-7300
Mailing Address - Fax:440-354-7301
Practice Address - Street 1:9485 MENTOR AVE STE 103
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-8722
Practice Address - Country:US
Practice Address - Phone:440-354-7300
Practice Address - Fax:440-354-7301
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.053714207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0629574Medicaid
OH2949519Medicaid
OH2949519Medicaid
OH0585791Medicare PIN