MEDICARE: CARO PEDIATRIC CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	35-056515-C	OH
2	208000000X	Pediatrics Physician	34-002567	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093084584
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARO PEDIATRIC CENTER

Provider Business Mailing Address
First Line	:	1435 SHOUP MILL RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45414-3978
Country	:	US
Telephone Number	:	937-275-3488
Fax Number	:	937-275-3371

Provider Business Practice Location Address
First Line	:	1435 SHOUP MILL RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45414-3978
Country	:	US
Telephone Number	:	937-275-3488
Fax Number	:	937-275-3371

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. STACY L GREEN
Credential	:
Telephone Number	:	937-275-8559

Provider Enumeration Date	:	12/29/2011
Last Update Date	:	12/29/2011

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Directions to “CARO PEDIATRIC CENTER ” Practice Location

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