Provider Demographics
NPI:1093801128
Name:CAVUTO, JOSEPH ANTHONY (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ANTHONY
Last Name:CAVUTO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-6206
Mailing Address - Country:US
Mailing Address - Phone:215-463-7373
Mailing Address - Fax:215-463-3204
Practice Address - Street 1:1525 S BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-6206
Practice Address - Country:US
Practice Address - Phone:215-463-7373
Practice Address - Fax:215-463-3204
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006193-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE43532Medicare UPIN
PA567554KFAMedicare ID - Type Unspecified