Provider Demographics
NPI:1023000759
Name:RICHARD F CARUSO MD PA
Entity Type:Organization
Organization Name:RICHARD F CARUSO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:CARUSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-645-6698
Mailing Address - Street 1:PO BOX 472
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-0472
Mailing Address - Country:US
Mailing Address - Phone:302-645-6698
Mailing Address - Fax:302-645-4505
Practice Address - Street 1:1309 SAVANNAH RD
Practice Address - Street 2:STE B
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-1514
Practice Address - Country:US
Practice Address - Phone:302-645-6698
Practice Address - Fax:305-645-4505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000776602Medicaid
DE0000776602Medicaid