=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558162024
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MD CENTER FOR VETERANS EDUCATION & TRAINING, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2025
-----------------------------------------------------
Last Update Date | 04/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 N HIGH ST
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21202-4801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-576-9626
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 301 N HIGH ST
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21202-4801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-576-9626
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF RESIDENT SERVICES
-----------------------------------------------------
Name | JOHN A CARUSO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 443-744-0126
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 302F00000X
-----------------------------------------------------
Taxonomy Name | Exclusive Provider Organization
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------