Provider Demographics
NPI:1558827204
Name:CUSACK, CAITLIN MARY (MD MPH)
Entity Type:Individual
Prefix:DR
First Name:CAITLIN
Middle Name:MARY
Last Name:CUSACK
Suffix:
Gender:F
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1356 S CAROLINA AVE SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-2371
Mailing Address - Country:US
Mailing Address - Phone:603-682-6594
Mailing Address - Fax:
Practice Address - Street 1:1356 S CAROLINA AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-2371
Practice Address - Country:US
Practice Address - Phone:603-682-6594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH8958207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology