Healthcare Provider Details

I. General information

NPI: 1609537851
Provider Name (Legal Business Name): PATRICK CALIFANO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2022
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 KEMPSVILLE RD BLDG A
NORFOLK VA
23502-4700
US

IV. Provider business mailing address

171 KEMPSVILLE RD BLDG A2ND
NORFOLK VA
23502-4700
US

V. Phone/Fax

Practice location:
  • Phone: 757-668-6575
  • Fax:
Mailing address:
  • Phone: 757-668-6550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number0110008814
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: