MEDICARE: RICHARD BERRY CASWELL JR. MD

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	2085R0202X	Diagnostic Radiology Physician	26482	SC
2	2085R0202X	Diagnostic Radiology Physician	224969	NY
3	2085R0202X	Diagnostic Radiology Physician	MD071482L	PA
4	2085R0202X	Diagnostic Radiology Physician	200301340	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00395923	OTHER	NC	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	135P1	OTHER	NC	BCBS

General Provider Information

NPI Number	:	1336153345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD BERRY CASWELL JR. MD

Provider Business Mailing Address
First Line	:	PO BOX 120590
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23612-0590
Country	:	US
Telephone Number	:	757-867-6101
Fax Number	:	757-867-6588

Provider Business Practice Location Address
First Line	:	1135 CARTHAGE ST
Second Line	:	CENTRAL CAROLINA HOSPITAL
City	:	SANFORD
State	:	NC
Zip	:	27330-4162
Country	:	US
Telephone Number	:	919-777-7092
Fax Number	:	919-774-2399

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	10/18/2007

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