Provider Demographics
NPI:1740243039
Name:CARUSI, DONATO ROCCO (MD)
Entity Type:Individual
Prefix:
First Name:DONATO
Middle Name:ROCCO
Last Name:CARUSI
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 1:110 MARILYN WAY
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-3253
Mailing Address - Country:US
Mailing Address - Phone:814-242-9500
Mailing Address - Fax:814-535-8315
Practice Address - Street 1:999 EISENHOWER BLVD
Practice Address - Street 2:STE I
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3347
Practice Address - Country:US
Practice Address - Phone:814-535-7661
Practice Address - Fax:814-535-8315
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-08
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036849E332H00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1059209Medicaid
PA0177290001Medicare NSC
PAC34167Medicare UPIN
PACA439196Medicare PIN