Provider Demographics
NPI:1255322194
Name:CALCAGNO PEDIATRICS PC
Entity Type:Organization
Organization Name:CALCAGNO PEDIATRICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:CALCAGNO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-491-0714
Mailing Address - Street 1:24850 SE STARK ST
Mailing Address - Street 2:STE 150
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-8316
Mailing Address - Country:US
Mailing Address - Phone:503-491-0714
Mailing Address - Fax:503-674-2834
Practice Address - Street 1:24850 SE STARK ST
Practice Address - Street 2:STE 150
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-8316
Practice Address - Country:US
Practice Address - Phone:503-491-0714
Practice Address - Fax:503-674-2834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR000136Medicaid