Provider Demographics
NPI:1124243050
Name:USSERY, CAROL B (MD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:B
Last Name:USSERY
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 1:8205 KIMBERSHELL PL
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-8436
Mailing Address - Country:US
Mailing Address - Phone:804-285-1192
Mailing Address - Fax:
Practice Address - Street 1:8205 KIMBERSHELL PL
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-8436
Practice Address - Country:US
Practice Address - Phone:804-285-1192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101042666207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAE58977Medicare UPIN