Healthcare Provider Details

I. General information

NPI: 1891799482
Provider Name (Legal Business Name): DAVID J CALDARELLA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 04/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 CENTERVILLE RD
WARWICK RI
02886-4336
US

IV. Provider business mailing address

120 CENTERVILLE RD
WARWICK RI
02886-4336
US

V. Phone/Fax

Practice location:
  • Phone: 401-738-3730
  • Fax: 401-738-3777
Mailing address:
  • Phone: 401-738-3730
  • Fax: 401-738-3777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberDPM00344
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: