Provider Demographics
NPI:1467633388
Name:WYNNE-ROBERTS, CAROLINE ROSALES SEAGER (MD)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:ROSALES SEAGER
Last Name:WYNNE-ROBERTS
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:PO BOX 1748
Mailing Address - Street 2:
Mailing Address - City:HILLSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24343-7748
Mailing Address - Country:US
Mailing Address - Phone:276-728-2436
Mailing Address - Fax:276-728-2436
Practice Address - Street 1:2477 HUFF HILL RD
Practice Address - Street 2:
Practice Address - City:HILLSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24343
Practice Address - Country:US
Practice Address - Phone:276-728-2436
Practice Address - Fax:276-728-2436
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171100000X
VA48727207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No171100000XOther Service ProvidersAcupuncturist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D09936Medicare UPIN