Provider Demographics
NPI:1922008192
Name:CAGGIANO, JOHN D (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:CAGGIANO
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 1:300 W COUNTRY CLUB RD
Mailing Address - Street 2:SUITE #130
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-5240
Mailing Address - Country:US
Mailing Address - Phone:575-624-4777
Mailing Address - Fax:575-624-8711
Practice Address - Street 1:300 W COUNTRY CLUB RD
Practice Address - Street 2:SUITE #130
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-5240
Practice Address - Country:US
Practice Address - Phone:575-624-4777
Practice Address - Fax:575-624-8711
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD012076207X00000X
NMMD2012-0238207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4362243OtherAETNA
PA1010368700001Medicaid
NM1922008192Medicaid
PA0105180OtherBCBS
PA611816800OtherUS DEPARTMENT OF WORKERS COMP
PA0025989000OtherBCBS
PA1296142OtherAETNA HMO
PA1565788OtherCIGNA
PA30030531OtherKEYSTONE MERCY
PA3157837OtherMAMSI
PA30030531OtherKEYSTONE MERCY
PA611816800OtherUS DEPARTMENT OF WORKERS COMP
PA105180VGUMedicare PIN
PA0025989000OtherBCBS