Provider Demographics
NPI:1578719217
Name:DAVID, CALVIN S
Entity Type:Individual
Prefix:
First Name:CALVIN
Middle Name:S
Last Name:DAVID
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 1:1625 N GEORGE MASON DR
Mailing Address - Street 2:SUITE 334
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-3683
Mailing Address - Country:US
Mailing Address - Phone:703-717-4250
Mailing Address - Fax:703-717-4251
Practice Address - Street 1:1625 N GEORGE MASON DR
Practice Address - Street 2:SUITE 334
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3683
Practice Address - Country:US
Practice Address - Phone:703-717-4250
Practice Address - Fax:703-717-4251
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP23574208600000X
VA0101253937208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery