Healthcare Provider Details

I. General information

NPI: 1255322194
Provider Name (Legal Business Name): CALCAGNO PEDIATRICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24850 SE STARK ST STE 150
GRESHAM OR
97030-8316
US

IV. Provider business mailing address

24850 SE STARK ST STE 150
GRESHAM OR
97030-8316
US

V. Phone/Fax

Practice location:
  • Phone: 503-491-0714
  • Fax: 503-674-2834
Mailing address:
  • Phone: 503-491-0714
  • Fax: 503-674-2834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateOR

VIII. Authorized Official

Name: DR. FRANK ANTHONY CALCAGNO
Title or Position: MD/OWNER
Credential: MD
Phone: 503-491-0714