Basic Information
| Provider Information | |||||||||
| NPI: | 1922089077 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLAUSTRO | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | CARINO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX CVPA | ||||||||
| Address2: | |||||||||
| City: | RICHLANDS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 246411102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2769646771 | ||||||||
| FaxNumber: | 2769641314 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 CLINIC DR | ||||||||
| Address2: | |||||||||
| City: | RICHLANDS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 246411102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2769646771 | ||||||||
| FaxNumber: | 2769641314 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2005 | ||||||||
| LastUpdateDate: | 02/13/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 0101035281 | VA | Y | Allopathic & Osteopathic Physicians | Surgery | 2086S0129X | 0101035281 | VA | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | 7332360 | 05 | VA | MEDICAID | 0128505-000 | 05 | WV | MEDICAID | 64007271 | 05 | KY | MEDICAID | 098098 | 01 | ANTHEM BCBS | OTHER |