Provider Demographics
NPI:1023081981
Name:CARUSO, KATHLEEN M (PA)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:CARUSO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1400 CENTRE STREET
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NEWTON CENTRE
Mailing Address - State:MA
Mailing Address - Zip Code:02459
Mailing Address - Country:US
Mailing Address - Phone:617-244-9929
Mailing Address - Fax:617-244-9935
Practice Address - Street 1:1400 CENTRE STREET
Practice Address - Street 2:SUITE 203
Practice Address - City:NEWTON CENTRE
Practice Address - State:MA
Practice Address - Zip Code:02459
Practice Address - Country:US
Practice Address - Phone:617-244-9929
Practice Address - Fax:617-244-9935
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA33363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS62758Medicare UPIN
MAAP0895Medicare ID - Type Unspecified