Healthcare Provider Details

I. General information

NPI: 1821168899
Provider Name (Legal Business Name): JOSEPH J CALANDRA II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2514 HARRIETS ISLAND CT
MT PLEASANT SC
29466-8048
US

IV. Provider business mailing address

2514 HARRIETS ISLAND CT
MT PLEASANT SC
29466-8048
US

V. Phone/Fax

Practice location:
  • Phone: 843-849-1588
  • Fax:
Mailing address:
  • Phone: 843-849-1588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number14244
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: