Provider Demographics
NPI:1013912393
Name:CALIA, GERALD B
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:B
Last Name:CALIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 RIDGEWAY CTR
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6926
Mailing Address - Country:US
Mailing Address - Phone:865-482-3441
Mailing Address - Fax:865-483-6299
Practice Address - Street 1:162 RIDGEWAY CTR
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6926
Practice Address - Country:US
Practice Address - Phone:865-482-3441
Practice Address - Fax:865-483-6299
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM264213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3351215Medicaid
TN38741OtherBLUE CROSS
TN3351215Medicare PIN
TNU25604Medicare UPIN
TN1232770001Medicare NSC