MEDICARE: DR. HENRY CALDERONI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	F8430	TX
2	207Q00000X	Family Medicine Physician	80-18	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	476935ZS5H	OTHER	NM	WELLMED PTAN
4	080166729	OTHER	TX	PALMETTO GBA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861483083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HENRY CALDERONI MD

Provider Business Mailing Address
First Line	:	5055 MCNUTT RD
Second Line	:
City	:	SANTA TERESA
State	:	NM
Zip	:	88008-9442
Country	:	US
Telephone Number	:	575-589-5005
Fax Number	:	575-589-1333

Provider Business Practice Location Address
First Line	:	5055 MCNUTT RD
Second Line	:
City	:	SANTA TERESA
State	:	NM
Zip	:	88008-9442
Country	:	US
Telephone Number	:	575-589-5005
Fax Number	:	575-589-1333

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2005
Last Update Date	:	06/15/2016

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Directions to “ DR. HENRY CALDERONI MD” Practice Location

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