Provider Demographics
NPI:1063597144
Name:CARUSO, JARED P (MD)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:P
Last Name:CARUSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6431 FANNIN STREET, JJL 434
Mailing Address - Street 2:UTHEALTH
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:713-500-7863
Mailing Address - Fax:
Practice Address - Street 1:17500 WEST GRAND PARKWAY SOUTH
Practice Address - Street 2:MEMORIAL HERMANN SUGAR LAND
Practice Address - City:SUGARL LAND
Practice Address - State:TX
Practice Address - Zip Code:77479
Practice Address - Country:US
Practice Address - Phone:281-725-5202
Practice Address - Fax:281-725-5678
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK72582080P0204X
PAMD423056208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4040384Medicaid
NJ0022560Medicaid
PA100846982Medicaid
PA100846982Medicaid
HO1661Medicare UPIN