Healthcare Provider Details

I. General information

NPI: 1194774885
Provider Name (Legal Business Name): JOHN A CAVALUZZI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 02/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 EASTERN AVE
BALTIMORE MD
21224
US

IV. Provider business mailing address

P.O. BOX 64358
BALTIMORE MD
21264
US

V. Phone/Fax

Practice location:
  • Phone: 410-550-0214
  • Fax:
Mailing address:
  • Phone: 410-550-2948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberD20816
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: