Healthcare Provider Details

I. General information

NPI: 1063765196
Provider Name (Legal Business Name): KATHLEEN ANN CALENDA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2012
Last Update Date: 10/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 JOSEPH CT
WARWICK RI
02886
US

IV. Provider business mailing address

185 JOSEPH CT
WARWICK RI
02886
US

V. Phone/Fax

Practice location:
  • Phone: 401-255-8292
  • Fax:
Mailing address:
  • Phone: 401-255-8292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number07468
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number07468
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: