Provider Demographics
NPI:1285654632
Name:CARUSO, JOHN R (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:CARUSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19808 BLUE HERON LN
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-1603
Mailing Address - Country:US
Mailing Address - Phone:301-745-3948
Mailing Address - Fax:
Practice Address - Street 1:17 WESTERN MARYLAND PKWY
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5146
Practice Address - Country:US
Practice Address - Phone:301-797-9240
Practice Address - Fax:301-797-4119
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0051043207T00000X
WV18854207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD138304300Medicaid
MDW2660001OtherMD BLUE SHIELD REGIONAL
PA145619OtherPA BLUE SHIELD PA LOC
PA400443OtherPA BLUE SHIELD MD LOC
MD68556206OtherMD BLUE SHIELD TRADITIONA
140005740OtherRR MEDICARE
PA001613M0TMedicare PIN
MD68556206OtherMD BLUE SHIELD TRADITIONA
140005740OtherRR MEDICARE