1750559126 NPI number — MS. KEISHANNA AMANDA MCCALMON M.S.

Table of content: MS. KEISHANNA AMANDA MCCALMON M.S. (NPI 1750559126)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750559126 NPI number — MS. KEISHANNA AMANDA MCCALMON M.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCALMON
Provider First Name:
KEISHANNA
Provider Middle Name:
AMANDA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750559126
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1532 MAIN ST
Provider Second Line Business Mailing Address:
2ND FLOOR NORTH
Provider Business Mailing Address City Name:
EAST HARTFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06108-1622
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-887-0312
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
91 NORTHWEST DR
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
PLAINVILLE
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06062-1534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-793-7243
Provider Business Practice Location Address Fax Number:
860-793-4497
Provider Enumeration Date:
02/19/2008

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: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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