MEDICARE: DR. CALVIN JOSEPH SMALL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD426237	PA

General Provider Information

NPI Number	:	1528374626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CALVIN JOSEPH SMALL M.D.

Provider Business Mailing Address
First Line	:	1832 FAIRMOUNT AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-2814
Country	:	US
Telephone Number	:	215-787-0244
Fax Number	:

Provider Business Practice Location Address
First Line	:	1832 FAIRMOUNT AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-2814
Country	:	US
Telephone Number	:	215-787-0244
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2010
Last Update Date	:	08/26/2010

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