Provider Demographics
NPI:1003018250
Name:CALCATERRA, DOMENICO (MD)
Entity Type:Individual
Prefix:DR
First Name:DOMENICO
Middle Name:
Last Name:CALCATERRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5304 4TH AVENUE CIR E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-5624
Mailing Address - Country:US
Mailing Address - Phone:941-744-2640
Mailing Address - Fax:941-744-2650
Practice Address - Street 1:1801 N SENATE BLVD
Practice Address - Street 2:STE 3300
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1228
Practice Address - Country:US
Practice Address - Phone:317-923-1787
Practice Address - Fax:317-962-6259
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97069208G00000X
IA38062208G00000X
IN01071025A208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201080180Medicaid
IN264430003Medicare PIN
IAP00642677Medicare PIN
IN201080180Medicaid
INP01118031Medicare PIN