Provider Demographics
NPI:1295720035
Name:CAVUTO-WILSON, CAROLYN M (DO)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:M
Last Name:CAVUTO-WILSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:M
Other - Last Name:CAVUTO-CARNIVALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1430 PURITAN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-1034
Mailing Address - Country:US
Mailing Address - Phone:609-534-5998
Mailing Address - Fax:609-488-6023
Practice Address - Street 1:231 HIGH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MOUNT HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060-1450
Practice Address - Country:US
Practice Address - Phone:609-534-5998
Practice Address - Fax:609-488-6023
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB63668207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7080107Medicaid
NJ553612YHEVMedicare PIN
NJ7080107Medicaid