1922008192 NPI number — JOHN D CAGGIANO M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922008192 NPI number — JOHN D CAGGIANO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAGGIANO
Provider First Name:
JOHN
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922008192
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/20/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 W COUNTRY CLUB RD
Provider Second Line Business Mailing Address:
SUITE #130
Provider Business Mailing Address City Name:
ROSWELL
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88201-5240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-624-4777
Provider Business Mailing Address Fax Number:
575-624-8711

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 W COUNTRY CLUB RD
Provider Second Line Business Practice Location Address:
SUITE #130
Provider Business Practice Location Address City Name:
ROSWELL
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88201-5240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-624-4777
Provider Business Practice Location Address Fax Number:
575-624-8711
Provider Enumeration Date:
07/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  MD012076 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207X00000X , with the licence number: MD2012-0238 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4362243 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1010368700001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1922008192 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0105180 . This is a "BCBS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 611816800 . This is a "US DEPARTMENT OF WORKERS COMP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0025989000 . This is a "BCBS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1296142 . This is a "AETNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1565788 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30030531 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3157837 . This is a "MAMSI" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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