Provider Demographics
NPI:1386775690
Name:VAN VLECK, CAROLINE (MD)
Entity type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:
Last Name:VAN VLECK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CAROLINE
Other - Middle Name:
Other - Last Name:CULVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4900 MASSACHUSETTS AVE., NW
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016
Mailing Address - Country:US
Mailing Address - Phone:202-966-1157
Mailing Address - Fax:202-966-5810
Practice Address - Street 1:4900 MASSACHUSETTS AVE., NW
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016
Practice Address - Country:US
Practice Address - Phone:202-966-1157
Practice Address - Fax:202-966-5810
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD20814208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics