Provider Demographics
NPI:1215161492
Name:VANDERZWAAG, CAROL JANE (MD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:JANE
Last Name:VANDERZWAAG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5509 CREEDMOOR RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-6312
Mailing Address - Country:US
Mailing Address - Phone:919-573-6520
Mailing Address - Fax:919-573-6555
Practice Address - Street 1:5509 CREEDMOOR RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-6312
Practice Address - Country:US
Practice Address - Phone:919-573-6520
Practice Address - Fax:919-573-6555
Is Sole Proprietor?:No
Enumeration Date:2009-05-04
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC344872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901986Medicaid