Provider Demographics
NPI:1790987386
Name:THEODORE A CALIANOS II MD PC
Entity Type:Organization
Organization Name:THEODORE A CALIANOS II MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:CALIANOS
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:508-539-6249
Mailing Address - Street 1:5 INDUSTRIAL DR
Mailing Address - Street 2:SUITE 109
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649
Mailing Address - Country:US
Mailing Address - Phone:508-539-6249
Mailing Address - Fax:508-539-6223
Practice Address - Street 1:5 INDUSTRIAL DR
Practice Address - Street 2:SUITE 109
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649
Practice Address - Country:US
Practice Address - Phone:508-539-6249
Practice Address - Fax:508-539-6223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA157231208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA157231OtherTUFTS
MA1528021813OtherNPI 1
MA21303OtherHARVARD PILGRIM HEALTHCAR
MA1300067OtherUNITED HEALTH CARE
MAJ19118OtherBLUS CROSS
MAJ19118OtherBLUS CROSS
MAG71486Medicare UPIN