Provider Demographics
NPI:1093906406
Name:CARNEY CALISCH, REBECCA KAY (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:KAY
Last Name:CARNEY CALISCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:KAY
Other - Last Name:CARNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1461 LARIMER RIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:TIMNATH
Mailing Address - State:CO
Mailing Address - Zip Code:80547-4454
Mailing Address - Country:US
Mailing Address - Phone:901-661-5841
Mailing Address - Fax:
Practice Address - Street 1:214 E 23RD ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3748
Practice Address - Country:US
Practice Address - Phone:307-634-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0073749207P00000X
CAA119600207P00000X
FLME100506207P00000X
PAMD432398207P00000X, 207PE0004X
ALMD29152207P00000X
KY57865207P00000X
GUM-2141207P00000X
TN65379207P00000X
CODR.0071427207P00000X
WY15998A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1093906406OtherNPI
FL281342400Medicaid
FL36243OtherBLUE CROSS BLUE SHIELD
AL1093906406Medicaid
CAA11960OtherLICENSE
FLP00622516OtherRAILROAD MEDICARE
PA102023900Medicaid
MDD0073749OtherSTATE LICENSE
PA1020239000001OtherPROMISE
CAA11960OtherLICENSE
PA118597JFGMedicare PIN