Provider Demographics
NPI:1639311624
Name:CALDERON, CECILIA BLANCAFLOR (MD)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:BLANCAFLOR
Last Name:CALDERON
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:PO BOX 23943
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21203-5943
Mailing Address - Country:US
Mailing Address - Phone:410-539-3417
Mailing Address - Fax:
Practice Address - Street 1:26 EAST MOUNT VERNON PLACE
Practice Address - Street 2:MAIN FLOOR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202
Practice Address - Country:US
Practice Address - Phone:410-539-3417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD37916207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDC14071Medicare UPIN