Provider Demographics
NPI:1780884064
Name:ROGERS-VIZENA, CAROLYN R (MD)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:R
Last Name:ROGERS-VIZENA
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Gender:F
Credentials:MD
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Mailing Address - Street 1:300 LONGWOOD AVE
Mailing Address - Street 2:CHILDREN'S HOSPITAL BOSTON
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-0001
Mailing Address - Country:US
Mailing Address - Phone:857-218-4947
Mailing Address - Fax:617-738-1657
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:CHILDREN'S HOSPITAL BOSTON
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-0001
Practice Address - Country:US
Practice Address - Phone:857-218-4947
Practice Address - Fax:617-738-1657
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2017-06-26
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Provider Licenses
StateLicense IDTaxonomies
MA250608208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA250608OtherMASS LIC #