1598766404 NPI number — DONALD CALEBAUGH MD

Table of content: DONALD CALEBAUGH MD (NPI 1598766404)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598766404 NPI number — DONALD CALEBAUGH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CALEBAUGH
Provider First Name:
DONALD
Provider Middle Name:
Provider Name Prefix Text:
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:
CALEBAUGH
Provider Other First Name:
DON
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD/MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1598766404
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 351
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PERRY
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04667-0351
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-853-0644
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11 BACK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLEASANT POINT
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04667-4119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-853-0644
Provider Business Practice Location Address Fax Number:
207-853-6230
Provider Enumeration Date:
08/02/2005

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: 207RG0100X , with the licence number:  223214 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02194338 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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