MEDICARE: DR. JOSEPH ANTHONY CAVUTO D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	OS006193-L	PA

General Provider Information

NPI Number	:	1093801128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH ANTHONY CAVUTO D.O.

Provider Business Mailing Address
First Line	:	1525 S BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-6206
Country	:	US
Telephone Number	:	215-463-7373
Fax Number	:	215-463-3204

Provider Business Practice Location Address
First Line	:	1525 S BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-6206
Country	:	US
Telephone Number	:	215-463-7373
Fax Number	:	215-463-3204

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	03/22/2016

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