Provider Demographics
NPI:1982648531
Name:KALGREN, CAROLYN E (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:E
Last Name:KALGREN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:ENGLEKING
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8308 CONSTITUTION PL NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7637
Mailing Address - Country:US
Mailing Address - Phone:505-883-9570
Mailing Address - Fax:505-883-4163
Practice Address - Street 1:8308 CONSTITUTION PL NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7637
Practice Address - Country:US
Practice Address - Phone:505-883-9570
Practice Address - Fax:505-883-4163
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM96386208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM27003Medicaid
NM27003Medicaid