Healthcare Provider Details

I. General information

NPI: 1689641995
Provider Name (Legal Business Name): DONALD L CALZOLAIO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2006
Last Update Date: 09/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 NORTH ST SUITE#4
AUBURN NY
13021-1852
US

IV. Provider business mailing address

17 LANSING ST AUBURN MEMORIAL MEDICAL SERVICES, PC
AUBURN NY
13021-1983
US

V. Phone/Fax

Practice location:
  • Phone: 315-252-5028
  • Fax: 315-252-1587
Mailing address:
  • Phone: 315-255-7438
  • Fax: 315-255-7099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number1873291
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: