Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 0101042197 | VA |
N | 208600000X | Surgeon | 0101042197 | VA |
Y | 2086S0120X | Pediatric Surgery | 12657 | WV |
NPI | 1477523967 |
---|---|
Provider Name | Dr. John Richard Casuccio |
First Address | Martinsburg, WV 25401-9000 |
Second Address | Martinsburg, WV 25401-9197 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2006 |
Last Update Date | 08/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3810011293 | (05) | WV |
B08277 | (02) | VA |