Provider Demographics
NPI:1639123722
Name:CALKINS, BEVERLY M (MD)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:M
Last Name:CALKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 SUNRISE AVE STE 612
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4548
Mailing Address - Country:US
Mailing Address - Phone:916-666-7215
Mailing Address - Fax:916-471-0165
Practice Address - Street 1:729 SUNRISE AVE STE 612
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4548
Practice Address - Country:US
Practice Address - Phone:916-666-7215
Practice Address - Fax:916-471-0165
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC54343207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD904400100Medicaid
754L703DOtherMEDICARE
MDG94975Medicare UPIN