Provider Demographics
NPI:1518074574
Name:CARUSO, JANIS MICHELE (MD)
Entity Type:Individual
Prefix:
First Name:JANIS
Middle Name:MICHELE
Last Name:CARUSO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8109 TIS WELL DR.
Mailing Address - Street 2:#511
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-3211
Mailing Address - Country:US
Mailing Address - Phone:703-799-9500
Mailing Address - Fax:703-799-9502
Practice Address - Street 1:8109 TIS WELL DR.
Practice Address - Street 2:STE. 511
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3211
Practice Address - Country:US
Practice Address - Phone:703-799-9500
Practice Address - Fax:703-799-9502
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101234464207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
3842373Medicare ID - Type Unspecified
G99344Medicare UPIN