Provider Demographics
NPI:1124564380
Name:CALDWELL, GINA (MSED)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 FARNES RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:NY
Mailing Address - Zip Code:13617-3723
Mailing Address - Country:US
Mailing Address - Phone:315-769-3000
Mailing Address - Fax:315-769-3002
Practice Address - Street 1:10 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MASSENA
Practice Address - State:NY
Practice Address - Zip Code:13662-1019
Practice Address - Country:US
Practice Address - Phone:315-769-3000
Practice Address - Fax:315-769-3002
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist