Provider Demographics
NPI:1467446344
Name:CACCAMESE, JOHN F JR (MD, DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:F
Last Name:CACCAMESE
Suffix:JR
Gender:M
Credentials:MD, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 W. BALTIMORE ST.
Mailing Address - Street 2:SUITE 1401
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201
Mailing Address - Country:US
Mailing Address - Phone:410-706-6195
Mailing Address - Fax:410-706-4199
Practice Address - Street 1:650 W. BALTIMORE ST.
Practice Address - Street 2:SUITE 1401
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201
Practice Address - Country:US
Practice Address - Phone:410-706-6195
Practice Address - Fax:410-706-4199
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD61608204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDJ384Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
MDI140704Medicare UPIN