1922089077 NPI number — DR. JOSEPH CARINO CLAUSTRO MD

Table of content: DR. JOSEPH CARINO CLAUSTRO MD (NPI 1922089077)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922089077 NPI number — DR. JOSEPH CARINO CLAUSTRO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLAUSTRO
Provider First Name:
JOSEPH
Provider Middle Name:
CARINO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922089077
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX CVPA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHLANDS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24641-1102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
276-964-6771
Provider Business Mailing Address Fax Number:
276-964-1314

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 CLINIC DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHLANDS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24641-1102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-964-6771
Provider Business Practice Location Address Fax Number:
276-964-1314
Provider Enumeration Date:
11/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  0101035281 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2086S0129X , with the licence number: 0101035281 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7332360 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0128505-000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64007271 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 098098 . This is a "ANTHEM BCBS" identifier . This identifiers is of the category "OTHER".




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