Provider Demographics
NPI:1770843914
Name:CALVO, JACQUELINE ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:ELIZABETH
Last Name:CALVO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2600 TAMARACK AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-5560
Mailing Address - Country:US
Mailing Address - Phone:860-646-1157
Mailing Address - Fax:
Practice Address - Street 1:2600 TAMARACK AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-5560
Practice Address - Country:US
Practice Address - Phone:860-646-1157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT054985207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology