Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | D0018013 | MD |
NPI | 1063476869 |
---|---|
Provider Name | Joseph Peter Caruso |
First Address | White Plains, MD 20695-2706 |
Second Address | Clinton, MD 20735-1628 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C61777 | (02) | MD |