Provider Demographics
NPI:1982031092
Name:CALVELLO, ANNE MARIE (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:ANNE MARIE
Middle Name:
Last Name:CALVELLO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANNE MARIE
Other - Middle Name:
Other - Last Name:O'HOLLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1030 NEW HOLLAND AVE
Mailing Address - Street 2:BLDG 12A SUITE 200
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17604-5690
Mailing Address - Country:US
Mailing Address - Phone:717-544-5028
Mailing Address - Fax:717-544-4296
Practice Address - Street 1:2102 HARRISBURG PIKE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2644
Practice Address - Country:US
Practice Address - Phone:717-544-9400
Practice Address - Fax:717-544-9401
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056545363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103199767Medicaid
PA399838Medicare PIN