Provider Demographics
NPI:1497345706
Name:KNOWLES, CALVIN MICHAEL
Entity Type:Individual
Prefix:
First Name:CALVIN
Middle Name:MICHAEL
Last Name:KNOWLES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:PROCTOR
Mailing Address - State:VT
Mailing Address - Zip Code:05765-1159
Mailing Address - Country:US
Mailing Address - Phone:802-310-8831
Mailing Address - Fax:
Practice Address - Street 1:100 MCGREGOR ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-3770
Practice Address - Country:US
Practice Address - Phone:603-669-0413
Practice Address - Fax:603-663-6350
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-20
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2041363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant