Healthcare Provider Details

I. General information

NPI: 1063476869
Provider Name (Legal Business Name): JOSEPH PETER CARUSO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 OLD BRANCH AVE SUITE D-203
CLINTON MD
20735-1628
US

IV. Provider business mailing address

10585 DEACON RD
WHITE PLAINS MD
20695-2706
US

V. Phone/Fax

Practice location:
  • Phone: 301-868-1220
  • Fax: 301-856-3550
Mailing address:
  • Phone: 301-934-1408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberD0018013
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: