Provider Demographics
NPI:1124043591
Name:CALDAROLA, VINCENT AUGUST (MD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:AUGUST
Last Name:CALDAROLA
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 1:4499 MEDICAL DRIVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229
Mailing Address - Country:US
Mailing Address - Phone:210-614-3565
Mailing Address - Fax:210-614-3563
Practice Address - Street 1:4499 MEDICAL DR
Practice Address - Street 2:SUITE 250
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3735
Practice Address - Country:US
Practice Address - Phone:210-614-3565
Practice Address - Fax:210-614-3563
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1345174400000X, 208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096562601Medicaid
TX096562601Medicaid