Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | 204105 | MA |
N | 207L00000X | Anesthesiologist | 228536 | MA |
Y | 207L00000X | Anesthesiologist | 5101019121 | MI |
NPI | 1003025362 |
---|---|
Provider Name | Peter Joseph Calkin |
First Address | Stoughton, MA 02072-3374 |
Second Address | Stoughton, MA 02072-3374 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 22/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0550900704 | BCBS (01) | MI |
1003025362 | (05) | MI |
P00936959 | RAILROAD MEDICARE (01) | MI |