Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 2018-02899 | NC |
N | 207N00000X | Dermatologist | OS13448 | FL |
N | 207NS0135X | Procedural Dermatology | 5101012868 | MI |
NPI | 1396790317 |
---|---|
Provider Name | Dr. Colene Marie Calo |
First Address | Charlotte, NC 28260-0447 |
Second Address | Huntersville, NC 28078-4913 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2006 |
Last Update Date | 04/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5500270 | BLUE CROSS BLUE SHIELD MI (01) | MI |
H04371 | (02) | MI |