Healthcare Provider Details

I. General information

NPI: 1144333972
Provider Name (Legal Business Name): THOMAS D CARUSO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 12/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 KEY PKWY SUITE 103
FREDERICK MD
21702-4053
US

IV. Provider business mailing address

PO BOX 2348
GERMANTOWN MD
20875-2348
US

V. Phone/Fax

Practice location:
  • Phone: 240-629-3939
  • Fax: 240-629-3932
Mailing address:
  • Phone: 240-629-3982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberDO23008
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberTC018927
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberH0074948
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: