Healthcare Provider Details

I. General information

NPI: 1386775690
Provider Name (Legal Business Name): CAROLINE VAN VLECK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROLINE CULVER M.D.

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 05/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 MASSACHUSETTS AVE., NW LOWER LEVEL
WASHINGTON DC
20016
US

IV. Provider business mailing address

4900 MASSACHUSETTS AVE., NW LOWER LEVEL
WASHINGTON DC
20016
US

V. Phone/Fax

Practice location:
  • Phone: 202-966-1157
  • Fax: 202-966-5810
Mailing address:
  • Phone: 202-966-1157
  • Fax: 202-966-5810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD20814
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: