MEDICARE: CHRISTOPHER L CASORIA IDMT

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	1710I1003X	Independent Duty Medical Technicians

General Provider Information

NPI Number	:	1407099773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER L CASORIA IDMT

Provider Business Mailing Address
First Line	:	PSC 3 BOX 3044
Second Line	:
City	:	APO
State	:	AP
Zip	:	96266-0030
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	PSC 3 BOX 3044
Second Line	:
City	:	APO
State	:	AP
Zip	:	96266-0030
Country	:	US
Telephone Number	:	943127842501
Fax Number	:

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

Provider Enumeration Date	:	04/15/2009
Last Update Date	:	04/15/2009

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