Provider Demographics
NPI:1043304959
Name:KALAFATIC, MARIA OLGA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:OLGA
Last Name:KALAFATIC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SHOREWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SANDS POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11050-1908
Mailing Address - Country:US
Mailing Address - Phone:718-328-2013
Mailing Address - Fax:347-726-3308
Practice Address - Street 1:1575 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-2912
Practice Address - Country:US
Practice Address - Phone:718-328-2013
Practice Address - Fax:347-726-3308
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208000000X208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00589648Medicaid
NY73A401Medicare ID - Type Unspecified