Provider Demographics
NPI:1093730772
Name:CALDERON, DANILO JOSON (MD)
Entity Type:Individual
Prefix:
First Name:DANILO
Middle Name:JOSON
Last Name:CALDERON
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:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-781-2210
Mailing Address - Fax:859-781-0289
Practice Address - Street 1:525 ALEXANDRIA PIKE
Practice Address - Street 2:SUITE 300
Practice Address - City:SOUTHGATE
Practice Address - State:KY
Practice Address - Zip Code:41071
Practice Address - Country:US
Practice Address - Phone:859-781-2210
Practice Address - Fax:859-781-0289
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39739207R00000X
KY42066207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100069240Medicaid
KYP00637558OtherMEDICARE RAILROAD
OH2966554Medicaid
KYP00839839OtherRAILROAD MEDICARE
KY7100069240Medicaid
KY0387554Medicare PIN
H46494Medicare UPIN