1750413837 NPI number — MICHAEL CARUSO PT PA

Table of content: (NPI 1750413837)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750413837 NPI number — MICHAEL CARUSO PT PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL CARUSO PT PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1750413837
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 618
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIGHLAND
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20777-0618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-418-4060
Provider Business Mailing Address Fax Number:
443-407-4466

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
RT 108 AND RT 216 (B.618)
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIGHLAND
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20777
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-418-4060
Provider Business Practice Location Address Fax Number:
443-407-4466
Provider Enumeration Date:
03/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CARUSO
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
LEON
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
410-418-4060

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  15253 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 35032204 . This is a "CAREFIRST PPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: G0021 . This is a "WORKER'S COMP" identifier . This identifiers is of the category "OTHER".
  • Identifier: H807 . This is a "CAREFIRST HMO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2662648 . This is a "AETNA HMO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 4401432 . This is a "AETNA PPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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