Provider Demographics
NPI:1134119605
Name:SYRACUSE, ROYCE ROSARIO (MD)
Entity type:Individual
Prefix:
First Name:ROYCE
Middle Name:ROSARIO
Last Name:SYRACUSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60160
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0160
Mailing Address - Country:US
Mailing Address - Phone:704-365-0555
Mailing Address - Fax:704-367-8122
Practice Address - Street 1:135 S SHARON AMITY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2842
Practice Address - Country:US
Practice Address - Phone:704-365-0555
Practice Address - Fax:704-367-8122
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2022-03-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC9901044207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCG91386Medicare UPIN
NC2274902AMedicare PIN