Provider Demographics
NPI:1275507030
Name:CALABRIA, WILLIAM A (DO)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
Last Name:CALABRIA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 601643
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1643
Mailing Address - Country:US
Mailing Address - Phone:980-487-3678
Mailing Address - Fax:980-487-3294
Practice Address - Street 1:201 E GROVER ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3917
Practice Address - Country:US
Practice Address - Phone:980-487-3678
Practice Address - Fax:980-487-3294
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07542900207R00000X
NC2009-02010207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1275507030Medicaid
SCNC1083Medicaid
NC5914223Medicaid
NC2075537AMedicare PIN
NC1275507030Medicaid
NC2075537Medicare PIN
NC5914223Medicaid