Provider Demographics
NPI:1326198946
Name:CALLIGARO, KEITH DON (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:DON
Last Name:CALLIGARO
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 1:700 SPRUCE ST
Mailing Address - Street 2:STE 101
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-0423
Mailing Address - Country:US
Mailing Address - Phone:215-829-5000
Mailing Address - Fax:215-829-0578
Practice Address - Street 1:700 SPRUCE ST
Practice Address - Street 2:STE 101
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-0423
Practice Address - Country:US
Practice Address - Phone:215-829-5000
Practice Address - Fax:215-829-0578
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD644059E2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00116801610001Medicaid
PA00116801610001Medicaid
E23151Medicare UPIN