Healthcare Provider Details

I. General information

NPI: 1467659441
Provider Name (Legal Business Name): MARIO JOSEPH CARMOSINO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 08/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 S EUCLID AVE
SAINT LOUIS MO
63110-1010
US

IV. Provider business mailing address

950 COLUMBIA AVE
FAIRVIEW HEIGHTS IL
62208-3791
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-6978
  • Fax:
Mailing address:
  • Phone: 303-667-1647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2007013989
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number48879
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: