Provider Demographics
NPI:1275557720
Name:CALENDA, CHARLES CARL (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:CARL
Last Name:CALENDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:639 METACOM AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:RI
Mailing Address - Zip Code:02885-2348
Mailing Address - Country:US
Mailing Address - Phone:401-245-3937
Mailing Address - Fax:401-245-8657
Practice Address - Street 1:639 METACOM AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:RI
Practice Address - Zip Code:02885-2348
Practice Address - Country:US
Practice Address - Phone:401-245-3937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD0605207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9002221Medicaid
MA050453705Medicaid
MA050453705Medicaid
RI9002221Medicaid
RI007010456Medicare ID - Type UnspecifiedGROUP PRACTICE NUMBER