Provider Demographics
NPI:1629038401
Name:CALISE, CRESCENZO GUILIO (MD)
Entity Type:Individual
Prefix:DR
First Name:CRESCENZO
Middle Name:GUILIO
Last Name:CALISE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 3RD AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5809
Mailing Address - Country:US
Mailing Address - Phone:570-288-3601
Mailing Address - Fax:570-288-1726
Practice Address - Street 1:423 3RD AVE
Practice Address - Street 2:SUITE B
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5809
Practice Address - Country:US
Practice Address - Phone:570-288-3601
Practice Address - Fax:570-288-1726
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-031942-E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2Y6969OtherHEALTHNET
PA0009642680002Medicaid
PA072892OtherFIRST PRIORITY HEALTH
PA0900660001OtherMEDICARE DME
PA000000075537OtherMEDPLUS
DC01042901OtherCAPITAL BLUE CROSS
PA20010385OtherAMERIHEALTH MERCY
PA505911OtherUSHEALTHCARE
DC01042901OtherCAPITAL BLUE CROSS
PA20010385OtherAMERIHEALTH MERCY