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General NPI Number Information
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NPI Number | 1588245773
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Entity Type | Individual
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Provider Name | JEREMY ANDREW CALDERWOOD DO
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Gender | Male
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Dates
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Enumeration Date | 04/19/2021
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Last Update Date | 07/11/2025
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Provider Practice Location Address
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Address Line | 610 CHESTNUT ST
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City | SOUTH CHARLESTON
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State | WV
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Zip | 25309-1251
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Country | US
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Telephone | 304-767-7790
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Fax |
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Provider Business Mailing Address
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Address Line | 2100 STANTONSBURG RD
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City | GREENVILLE
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State | NC
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Zip | 27834-2818
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Country | US
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Telephone | 252-551-1066
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 4685
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License Number State | WV
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