MEDICARE: LORI ANNE CARUSO MD

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	173000000X	Legal Medicine	190507	NY
2	208000000X	Pediatrics Physician	1770552309	NY

General Provider Information

NPI Number	:	1770552309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI ANNE CARUSO MD

Provider Business Mailing Address
First Line	:	315 2ND AVE
Second Line	:
City	:	TROY
State	:	NY
Zip	:	12182-3237
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	315 2ND AVE
Second Line	:
City	:	TROY
State	:	NY
Zip	:	12182-3237
Country	:	US
Telephone Number	:	518-235-6181
Fax Number	:	518-237-2465

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	05/12/2021

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