Provider Demographics
NPI:1912034612
Name:CONROY, ROSOLENA VISCO (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSOLENA
Middle Name:VISCO
Last Name:CONROY
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 1:170 DAVIDSON HWY
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-4245
Mailing Address - Country:US
Mailing Address - Phone:980-209-6328
Mailing Address - Fax:
Practice Address - Street 1:280 CONCORD PKWY S STE 100
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-2705
Practice Address - Country:US
Practice Address - Phone:980-209-6328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA16413101YP2500X
101YM0800X
NC9700041208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5950393OtherCIGNA HEALTHCARE
NC1019EOtherBCBS
NC891019EMedicaid
NC891019EMedicaid