Provider Demographics
NPI:1225038607
Name:FINE, CALLIOPE (MD)
Entity Type:Individual
Prefix:
First Name:CALLIOPE
Middle Name:
Last Name:FINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 POND AVE
Mailing Address - Street 2:SUITE 2013
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7102
Mailing Address - Country:US
Mailing Address - Phone:617-232-4600
Mailing Address - Fax:617-232-4405
Practice Address - Street 1:55 POND AVE
Practice Address - Street 2:SUITE 201E
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7102
Practice Address - Country:US
Practice Address - Phone:617-232-4600
Practice Address - Fax:617-232-4405
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA405622085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6164269Medicaid
MA6164269Medicaid
MAB74162Medicare UPIN