Healthcare Provider Details

I. General information

NPI: 1215340286
Provider Name (Legal Business Name): RICHARD CHARLES CALDERONE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2014
Last Update Date: 01/01/2026
Certification Date: 01/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6051 U S HIGHWAY 49
HATTIESBURG MS
39401-7200
US

IV. Provider business mailing address

116 CARRIE RD
HATTIESBURG MS
39402-3089
US

V. Phone/Fax

Practice location:
  • Phone: 601-288-7000
  • Fax:
Mailing address:
  • Phone: 601-441-6731
  • Fax: 601-401-4102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number24158
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number24158
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number24158
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: