Provider Demographics
NPI:1750588430
Name:VIA, CAROLINE ROSE (MD)
Entity type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:ROSE
Last Name:VIA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1345 RXR PLZ FL 13
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11556-1301
Mailing Address - Country:US
Mailing Address - Phone:516-453-0435
Mailing Address - Fax:646-846-3283
Practice Address - Street 1:415 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4812
Practice Address - Country:US
Practice Address - Phone:516-829-2273
Practice Address - Fax:516-829-2272
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2019-12-05
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Provider Licenses
StateLicense IDTaxonomies
NY243869-1207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02916714Medicaid