Provider Demographics
NPI:1023128774
Name:CALHOUN, JEAN K (MD)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:K
Last Name:CALHOUN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 HICKORY PARK DR STE A
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-2623
Mailing Address - Country:US
Mailing Address - Phone:804-262-6060
Mailing Address - Fax:804-262-6422
Practice Address - Street 1:5201 HICKORY PARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-2623
Practice Address - Country:US
Practice Address - Phone:804-262-6060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA46085207N00000X
VA0101248492207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0014518OtherNEIGHBORHOOD HEALTH PLAN
MA7507775-002OtherCIGNA
MAPD139OtherHARVARD PILGRIM
MA3184501Medicaid
MAE05812OtherBLUE CROSS
MA046085OtherTUFTS HEALTH PLAN
MAPD139OtherHARVARD PILGRIM
MA3184501Medicaid