Provider Demographics
NPI:1508826439
Name:CALABRESE, JOANNE (DO)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:CALABRESE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1299 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:TAMAQUA
Mailing Address - State:PA
Mailing Address - Zip Code:18252-2229
Mailing Address - Country:US
Mailing Address - Phone:570-668-6541
Mailing Address - Fax:570-668-6545
Practice Address - Street 1:1299 E BROAD ST
Practice Address - Street 2:
Practice Address - City:TAMAQUA
Practice Address - State:PA
Practice Address - Zip Code:18252-2229
Practice Address - Country:US
Practice Address - Phone:570-668-6541
Practice Address - Fax:570-668-6545
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009314L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017470280008Medicaid
PA024868Medicare ID - Type UnspecifiedMEDICARE
PAG88289Medicare UPIN