Healthcare Provider Details

I. General information

NPI: 1841229267
Provider Name (Legal Business Name): BRENT W CALHOON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 04/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1903 MORGANTOWN RD INTEGRATED MEDICAL GROUP/GREENHILLS FAMILY PRACTICE
READING PA
19607-9620
US

IV. Provider business mailing address

1903 MORGANTOWN RD INTEGRATED MEDICAL GROUP/GREENHILLS FAMILY PRACTICE
READING PA
19607-9620
US

V. Phone/Fax

Practice location:
  • Phone: 610-777-4040
  • Fax: 610-777-5575
Mailing address:
  • Phone: 610-777-4040
  • Fax: 610-777-5575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA003345L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: