Provider Demographics
NPI:1285629857
Name:CANIZARES, ROBERTO RAMOS (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:RAMOS
Last Name:CANIZARES
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 1:11131 JOURNAL PKWY
Mailing Address - Street 2:
Mailing Address - City:KING GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:22485-3468
Mailing Address - Country:US
Mailing Address - Phone:540-625-2527
Mailing Address - Fax:540-709-7211
Practice Address - Street 1:11131 JOURNAL PKWY
Practice Address - Street 2:
Practice Address - City:KING GEORGE
Practice Address - State:VA
Practice Address - Zip Code:22485-3468
Practice Address - Country:US
Practice Address - Phone:540-625-2527
Practice Address - Fax:540-709-7211
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101025116208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA501033OtherAETNA
VA4091663OtherAETNA
VA001368OtherANTHEM BCBS
VA4091663OtherAETNA