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Diego Martin Caivano

Emergency Medicine

Allopathic & Osteopathic Physicians

3300 Gallows Rd, Falls Church, VA 22042-3307

PECOS Enrollment

This provider is enrolled in PECOS as DIEGO CAIVANO.

Based on the most recent information from CMS, provider Diego Martin Caivano is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1629271408
Provider Type
Individual
Full Name
Caivano, Diego Martin
Title
Dr.
Credential
M.D.

Gender
Male
Sole Proprietor
No
Enumeration Date
6/7/2007
Last Updated
12/1/2021

Contact Information

Practice Location

3300 Gallows Rd, Falls Church, VA 22042-3307

(904) 346-0113

Unlisted Fax

Mailing Location

393 E Walnut St, Phr Group Provider Enrollment Unit 3rd Fl, Pasadena, CA 91188-0001

(877) 608-0044

(877) 514-0903

Provider Taxonomies

Code	Description	License
Code 207P00000X Primary	Description Emergency Medicine Allopathic & Osteopathic Physicians	License C54160 California
Code 207P00000X	Description Emergency Medicine Allopathic & Osteopathic Physicians	License 234090-1 New York
Code 207P00000X	Description Emergency Medicine Allopathic & Osteopathic Physicians	License 0101241979 Virginia

Diego Martin Caivano

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Code

Description

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