Individual
CARISSA JEAN ILDEFONSO VEA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6000 EXECUTIVE BLVD STE 625, ROCKVILLE, MD 20852-3877
(240) 314-7080
Mailing address
9910 FRANKLIN SQUARE DR # 2110, BALTIMORE, MD 21236-4902
(410) 933-5412
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
D0069419
MD
207Q00000X
Family Medicine Physician
MT188480
PA
Other
Enumeration date
05/14/2007
Last updated
06/04/2018
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