Provider Demographics
NPI:1427052117
Name:CARUSO, DAVID M (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:CARUSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:100 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1440
Mailing Address - Country:US
Mailing Address - Phone:814-837-5402
Mailing Address - Fax:814-837-2257
Practice Address - Street 1:761 JOHNSONBURG ROAD
Practice Address - Street 2:SUITE 240
Practice Address - City:ST MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857-1349
Practice Address - Country:US
Practice Address - Phone:814-834-6565
Practice Address - Fax:814-834-7424
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2015-01-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD022209E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA8085210001Medicaid
PA8085210001Medicaid
PA112090FFUMedicare UPIN