Provider Demographics
NPI:1326467358
Name:CALVIN, WANDA (MD)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:
Last Name:CALVIN
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 1:9815 BROWNSBORO RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-2225
Mailing Address - Country:US
Mailing Address - Phone:502-426-4264
Mailing Address - Fax:502-426-4264
Practice Address - Street 1:9815 BROWNSBORO RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2225
Practice Address - Country:US
Practice Address - Phone:502-426-4264
Practice Address - Fax:502-426-4264
Is Sole Proprietor?:No
Enumeration Date:2014-04-07
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY49985207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine