Provider Demographics
NPI:1598098402
Name:VINLUAN, MARIA THERESA CASTOR (MD)
Entity Type:Individual
Prefix:
First Name:MARIA THERESA
Middle Name:CASTOR
Last Name:VINLUAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA THERESA
Other - Middle Name:
Other - Last Name:CASTOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2015 GRAND CONCOURSE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-4303
Mailing Address - Country:US
Mailing Address - Phone:718-294-6275
Mailing Address - Fax:
Practice Address - Street 1:2015 GRAND CONCOURSE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-4303
Practice Address - Country:US
Practice Address - Phone:718-294-6275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-09
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208958207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine