Provider Demographics
NPI:1528021813
Name:CALIANOS, THEODORE ARTHUR II (MD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:ARTHUR
Last Name:CALIANOS
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:151 WHITMAR RD
Mailing Address - Street 2:
Mailing Address - City:COTUIT
Mailing Address - State:MA
Mailing Address - Zip Code:02635-2931
Mailing Address - Country:US
Mailing Address - Phone:508-428-3468
Mailing Address - Fax:
Practice Address - Street 1:5 INDUSTRIAL DR
Practice Address - Street 2:SUITE 109
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649-3464
Practice Address - Country:US
Practice Address - Phone:508-539-6220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-09
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA157231208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ19118OtherBC/BS
MA13-00067OtherUNITED HEALTH CARE
MA21303OtherHARVARD PILGRIM
MA157231OtherLICENSE
MAB20800901OtherCIGNA HEALTH
MA15231OtherTUFTS
TXJ1906OtherMEDICAL LICENSE
MA13-00067OtherUNITED HEALTH CARE
MACAA28455Medicare ID - Type Unspecified