Provider Demographics
NPI:1821291303
Name:ROUNTREE, CARL B JR (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:B
Last Name:ROUNTREE
Suffix:JR
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 1:5875 BREMO RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1934
Mailing Address - Country:US
Mailing Address - Phone:804-893-8610
Mailing Address - Fax:804-287-7285
Practice Address - Street 1:5875 BREMO RD
Practice Address - Street 2:SUITE 303
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1934
Practice Address - Country:US
Practice Address - Phone:804-893-8610
Practice Address - Fax:804-287-7285
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4314472080P0206X
VA01012516382080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06778OtherGROUP PTAN
PAMD431447OtherMEDICAL LICENSE