Provider Demographics
NPI:1598981300
Name:CALKA, CARYN F (PAC)
Entity Type:Individual
Prefix:
First Name:CARYN
Middle Name:F
Last Name:CALKA
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 IDLEWILD AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-3881
Mailing Address - Country:US
Mailing Address - Phone:410-820-8226
Mailing Address - Fax:410-820-8405
Practice Address - Street 1:510 IDLEWILD AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-3881
Practice Address - Country:US
Practice Address - Phone:410-820-8226
Practice Address - Fax:410-820-8405
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0003502363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD494914ZP1Medicare PIN
MD195542ZCXDMedicare PIN