Healthcare Provider Details

I. General information

NPI: 1982150850
Provider Name (Legal Business Name): SAMANTHA CALABRESE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2016
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST WANG 5 GASTROENTEROLOGY
BOSTON MA
02114-2621
US

IV. Provider business mailing address

55 FRUIT ST WANG 5 GASTROENTEROLOGY
BOSTON MA
02114-2621
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-6038
  • Fax: 617-726-3080
Mailing address:
  • Phone: 617-724-6038
  • Fax: 617-726-3080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2303104
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2303104
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: