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NPI Code Detail

MEDICARE: CARA VITA TILLOTSON D.O.

MEDICARE: CARA VITA TILLOTSON D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician0102204418VA
2390200000XStudent in an Organized Health Care Education/Training Program
32080P0205XPediatric Endocrinology Physician0102204418VA

General Provider Information

NPI Number : 1902148737
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARA VITA TILLOTSON D.O.
Provider Business Mailing Address
First Line : 213 S JEFFERSON ST STE 1006
Second Line :
City : ROANOKE
State : VA
Zip : 24011-1713
Country : US
Telephone Number : 540-224-5516
Fax Number :
Provider Business Practice Location Address
First Line : 4348 ELECTRIC RD
Second Line :
City : ROANOKE
State : VA
Zip : 24018-0720
Country : US
Telephone Number : 540-769-0976
Fax Number : 540-857-5388
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/19/2013
Last Update Date : 05/07/2026

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