1558597096 NPI number — DR. LARISSA ANN CALKA GEMME D.O.

Table of content: DR. LARISSA ANN CALKA GEMME D.O. (NPI 1558597096)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558597096 NPI number — DR. LARISSA ANN CALKA GEMME D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GEMME
Provider First Name:
LARISSA
Provider Middle Name:
ANN CALKA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CALKA
Provider Other First Name:
LARISSA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1558597096
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 CUMMINGS CENTER
Provider Second Line Business Mailing Address:
SUITE 107T
Provider Business Mailing Address City Name:
BEVERLY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01915
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-922-0357
Provider Business Mailing Address Fax Number:
978-922-1105

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 CUMMINGS CENTER
Provider Second Line Business Practice Location Address:
SUITE 107T
Provider Business Practice Location Address City Name:
BEVERLY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-922-0357
Provider Business Practice Location Address Fax Number:
978-922-1105
Provider Enumeration Date:
06/10/2009

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: 207Q00000X , with the licence number:  250205 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 204D00000X , with the licence number: 250205 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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