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Individual
DR. MARY T CACCAVO
Active
Individual
DR. MARY T CACCAVO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
23001132A
IN
237600000X
Audiologist-Hearing Aid Fitter
23001132A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000202141
BCBS UAW
IN
01
—
000000220882
BCBS UAW
IN
01
—
000000220890
BLUE CROSS BLUE SHIELD
IN
05
—
100232400A
—
IN
01
—
640004350
RAILROAD MEDICARE
IN
Enumeration date
10/05/2005
Last updated
06/28/2010
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