Provider Demographics
NPI:1922089077
Name:CLAUSTRO, JOSEPH CARINO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:CARINO
Last Name:CLAUSTRO
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:PO BOX CVPA
Mailing Address - Street 2:
Mailing Address - City:RICHLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:24641-1102
Mailing Address - Country:US
Mailing Address - Phone:276-964-6771
Mailing Address - Fax:276-964-1314
Practice Address - Street 1:1 CLINIC DR
Practice Address - Street 2:
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641-1102
Practice Address - Country:US
Practice Address - Phone:276-964-6771
Practice Address - Fax:276-964-1314
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101035281208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7332360Medicaid
WV0128505-000Medicaid
KY64007271Medicaid
098098OtherANTHEM BCBS
WV0128505-000Medicaid