Provider Demographics
NPI:1851365084
Name:CARAG, VICENTE REYES JR (MD)
Entity Type:Individual
Prefix:DR
First Name:VICENTE
Middle Name:REYES
Last Name:CARAG
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:504 LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-3420
Mailing Address - Country:US
Mailing Address - Phone:410-939-0700
Mailing Address - Fax:410-939-0703
Practice Address - Street 1:504 LEWIS ST
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-3420
Practice Address - Country:US
Practice Address - Phone:410-939-0700
Practice Address - Fax:410-939-0703
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD17195208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD70334Medicare UPIN