Provider Demographics
NPI:1598766404
Name:CALEBAUGH, DONALD (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:CALEBAUGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DON
Other - Middle Name:
Other - Last Name:CALEBAUGH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD/MD
Mailing Address - Street 1:PO BOX 351
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:ME
Mailing Address - Zip Code:04667-0351
Mailing Address - Country:US
Mailing Address - Phone:207-853-0644
Mailing Address - Fax:
Practice Address - Street 1:11 BACK RD
Practice Address - Street 2:
Practice Address - City:PLEASANT POINT
Practice Address - State:ME
Practice Address - Zip Code:04667-4119
Practice Address - Country:US
Practice Address - Phone:207-853-0644
Practice Address - Fax:207-853-6230
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223214207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02194338Medicaid
NYCC7986Medicare ID - Type Unspecified
NY02194338Medicaid