=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851399000
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAUL JOHN CARO MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2005
-----------------------------------------------------
Last Update Date | 05/08/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6970 ERIE ROAD ROUTE 5 SUITE A
-----------------------------------------------------
City | DERBY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14047-9592
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-947-9147
-----------------------------------------------------
Fax | 716-947-5175
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6970 ERIE RD ROUTE 5 SUITE A
-----------------------------------------------------
City | DERBY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14047-9592
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-947-9147
-----------------------------------------------------
Fax | 716-947-5175
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 180738
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------