Provider Demographics
NPI:1215328760
Name:CARUSO, MICHAEL
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:CARUSO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 618
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20777-0618
Mailing Address - Country:US
Mailing Address - Phone:410-418-4060
Mailing Address - Fax:443-407-4466
Practice Address - Street 1:RT 108 AND RT 216 (B. 618)
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:MD
Practice Address - Zip Code:20777
Practice Address - Country:US
Practice Address - Phone:410-418-4060
Practice Address - Fax:443-407-4466
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD152532251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKQ65LP69Medicare UPIN