Provider Demographics
NPI:1154423143
Name:ZOGRAN, CAROL ELIZABETH (CNS)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ELIZABETH
Last Name:ZOGRAN
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1394 MANAKIN RD
Mailing Address - Street 2:
Mailing Address - City:MANAKIN SABOT
Mailing Address - State:VA
Mailing Address - Zip Code:23103-2806
Mailing Address - Country:US
Mailing Address - Phone:804-784-9847
Mailing Address - Fax:
Practice Address - Street 1:1503 SANTA ROSA RD
Practice Address - Street 2:SUITE 211
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-5105
Practice Address - Country:US
Practice Address - Phone:804-282-9100
Practice Address - Fax:804-282-3266
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0015000375364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09633OtherGROUP PTAN
VAS29226Medicare UPIN
VA890000149Medicare ID - Type Unspecified