Provider Demographics
NPI:1164432381
Name:KRAMER, CAROLINE (MD)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:KRAMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5303 INDIAN GRAVE RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-9107
Mailing Address - Country:US
Mailing Address - Phone:540-725-3060
Mailing Address - Fax:540-772-4948
Practice Address - Street 1:5303 INDIAN GRAVE RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-9107
Practice Address - Country:US
Practice Address - Phone:540-725-3060
Practice Address - Fax:540-772-4948
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICK064133207Q00000X
VA0101247971207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1164432381Medicaid
VA1164432381Medicaid
VAA103090Medicare PIN
P00877552Medicare PIN