Healthcare Provider Details

I. General information

NPI: 1427052117
Provider Name (Legal Business Name): DAVID M CARUSO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 01/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

761 JOHNSONBURG ROAD SUITE 240
ST MARYS PA
15857-1349
US

IV. Provider business mailing address

100 HOSPITAL AVE
DU BOIS PA
15801-1440
US

V. Phone/Fax

Practice location:
  • Phone: 814-834-6565
  • Fax: 814-834-7424
Mailing address:
  • Phone: 814-837-5402
  • Fax: 814-837-2257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD022209E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: