Healthcare Provider Details

I. General information

NPI: 1750389854
Provider Name (Legal Business Name): ROGER M KALDAWY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 06/07/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 S MAIN ST
MILFORD MA
01757-3293
US

IV. Provider business mailing address

160 S MAIN ST
MILFORD MA
01757-3293
US

V. Phone/Fax

Practice location:
  • Phone: 85-473-7939
  • Fax: 508-473-3932
Mailing address:
  • Phone: 508-473-7939
  • Fax: 508-473-3932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number209960
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: