Provider Demographics
NPI:1194837633
Name:CALAMAS, MARILEE M (NP)
Entity Type:Individual
Prefix:
First Name:MARILEE
Middle Name:M
Last Name:CALAMAS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 602362
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2362
Mailing Address - Country:US
Mailing Address - Phone:803-547-7541
Mailing Address - Fax:803-548-0122
Practice Address - Street 1:1690 HIGHWAY 160 WEST
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-8024
Practice Address - Country:US
Practice Address - Phone:803-547-7541
Practice Address - Fax:803-548-0122
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCAPN1206363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP94259Medicare UPIN
SCAA49238371Medicare Oscar/Certification
SCP942598371Medicare ID - Type Unspecified