Healthcare Provider Details

I. General information

NPI: 1932197514
Provider Name (Legal Business Name): CAROL E CALHOUN RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2005
Last Update Date: 08/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1185 SWEET HOME RD
AMHERST NY
14226-1018
US

IV. Provider business mailing address

1185 SWEET HOME RD ATTN: CREDENTIALING
AMHERST NY
14226-1018
US

V. Phone/Fax

Practice location:
  • Phone: 716-668-9004
  • Fax: 716-422-2802
Mailing address:
  • Phone: 716-689-0040
  • Fax: 716-422-2802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0094001
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: