Provider Demographics
NPI:1598770372
Name:ST. REMY, CARL RAPHAEL (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:RAPHAEL
Last Name:ST. REMY
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 741593
Mailing Address - Street 2:CHILDRENS SURGICAL SPECIALTY GROUP INC
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-1593
Mailing Address - Country:US
Mailing Address - Phone:757-668-8544
Mailing Address - Fax:757-668-6544
Practice Address - Street 1:171 KEMPSVILLE RD
Practice Address - Street 2:BUILDING A
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4700
Practice Address - Country:US
Practice Address - Phone:757-668-6550
Practice Address - Fax:757-668-6544
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2016-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101235869207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA104676OtherANTHEM BCBS
VA65775OtherOPTIMA/SENTARA HEALTH
NC669649OtherNC PPO
NC790661POtherNC MEDICAID
VA010060842OtherVA PREMIER
VA010060842Medicaid
VA09-01530OtherUHC
VA007573642OtherMEDICARE
VA7338381OtherAETNA
VA790661POtherNORTH CAROLINA MEDICAID
VA1598770372OtherTRICARE
VA4122371004OtherCIGNA