Healthcare Provider Details

I. General information

NPI: 1922062793
Provider Name (Legal Business Name): VINCENT D CARUANA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 ALICE PECK DAY DR DARTMOUTH HITCHCOCK - RADIOLOGY
LEBANON NH
03766
US

IV. Provider business mailing address

PO BOX 802843
KANSAS CITY MO
64180-2843
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-7650
  • Fax:
Mailing address:
  • Phone: 417-875-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number10746
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number10746
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: