Healthcare Provider Details

I. General information

NPI: 1073197851
Provider Name (Legal Business Name): COURTNEY MARIE CARUSO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2021
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9901 MEDICAL CENTER DR
ROCKVILLE MD
20850-3357
US

IV. Provider business mailing address

9901 MEDICAL CENTER DR
ROCKVILLE MD
20850-3357
US

V. Phone/Fax

Practice location:
  • Phone: 631-792-3365
  • Fax:
Mailing address:
  • Phone: 240-826-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: