Provider Demographics
NPI:1023294394
Name:DONATO R CARUSI, M. D.
Entity type:Organization
Organization Name:DONATO R CARUSI, M. D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:DONATO
Authorized Official - Middle Name:R
Authorized Official - Last Name:CARUSI
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:814-535-7661
Mailing Address - Street 1:321 MAIN ST
Mailing Address - Street 2:SUITE 4B
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15901-1632
Mailing Address - Country:US
Mailing Address - Phone:814-535-7661
Mailing Address - Fax:814-535-3106
Practice Address - Street 1:321 MAIN ST
Practice Address - Street 2:SUITE 4B
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15901-1632
Practice Address - Country:US
Practice Address - Phone:814-535-7661
Practice Address - Fax:814-535-3106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036849E332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010592090002Medicaid
C34167Medicare UPIN
PA0010592090002Medicaid