Healthcare Provider Details

I. General information

NPI: 1023139706
Provider Name (Legal Business Name): ALICE ANN CALHOUN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 09/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 S TALBOT STREET UNIT 4
ST MICHAELS MD
21663-2633
US

IV. Provider business mailing address

301 RANDOLPH ST
DENTON MD
21629-1243
US

V. Phone/Fax

Practice location:
  • Phone: 410-745-0200
  • Fax: 410-745-0492
Mailing address:
  • Phone: 410-479-4306
  • Fax: 410-479-1714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE2366
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0066684
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: