Provider Demographics
NPI:1477591162
Name:CALCUTT, VONDA GILGEN (MD)
Entity Type:Individual
Prefix:
First Name:VONDA
Middle Name:GILGEN
Last Name:CALCUTT
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 1:16 NORTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29488-7219
Mailing Address - Country:US
Mailing Address - Phone:843-538-8585
Mailing Address - Fax:843-538-4777
Practice Address - Street 1:16 NORTHSIDE DR
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-7219
Practice Address - Country:US
Practice Address - Phone:843-538-8585
Practice Address - Fax:843-538-4777
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20023207RE0101X
GA036509207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC42D0952228OtherRAILROAD MEDICARE
SC200231Medicaid
SCG418430281Medicare PIN