Provider Demographics
NPI:1205021805
Name:SAMUEL S CALDWELL, MD
Entity Type:Organization
Organization Name:SAMUEL S CALDWELL, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:CALDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-584-0295
Mailing Address - Street 1:19 WEST AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-6049
Mailing Address - Country:US
Mailing Address - Phone:518-584-0295
Mailing Address - Fax:518-584-0296
Practice Address - Street 1:19 WEST AVE
Practice Address - Street 2:STE 102
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-6049
Practice Address - Country:US
Practice Address - Phone:518-584-0295
Practice Address - Fax:518-584-0296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147389207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0069716OtherGHI
NY00733124Medicaid
000406955001OtherBLUE SHIELD
85E121OtherBLUE CROSS
113749OtherWELLCARE
18120OtherMVP
2582OtherCDPHP
113749OtherWELLCARE
2582OtherCDPHP
0779470001Medicare NSC