Provider Demographics
NPI:1134298896
Name:CARUSO, MARK PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:PAUL
Last Name:CARUSO
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Gender:M
Credentials:MD
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Mailing Address - Street 1:713 BROADWAY ST
Mailing Address - Street 2:STE 203
Mailing Address - City:PAINTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41240-1612
Mailing Address - Country:US
Mailing Address - Phone:606-789-4949
Mailing Address - Fax:606-789-7690
Practice Address - Street 1:713 BROADWAY ST STE 203
Practice Address - Street 2:
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240-1612
Practice Address - Country:US
Practice Address - Phone:606-789-4949
Practice Address - Fax:606-789-7690
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2013-06-20
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Provider Licenses
StateLicense IDTaxonomies
KY26513207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY11026000OtherRR MEDICARE UHC
KY000000049250OtherANTHEM BC BS
KY018956500OtherUS DEPT. OF LABOR
KY64265135Medicaid
KY000000049250OtherANTHEM BC BS
KY11026000OtherRR MEDICARE UHC