Healthcare Provider Details

I. General information

NPI: 1124602453
Provider Name (Legal Business Name): ANTONINA LOUISE CALCAVECCHIO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANTONINA LOUISE CALCAVECCHIO

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1617 N JAMES ST
ROME NY
13440-2852
US

IV. Provider business mailing address

111 HOSPITAL DR
UTICA NY
13502-2517
US

V. Phone/Fax

Practice location:
  • Phone: 315-336-8260
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0102209715
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number328694
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: