Provider Demographics
NPI:1124602453
Name:CALCAVECCHIO, ANTONINA (DO)
Entity type:Individual
Prefix:MS
First Name:ANTONINA
Middle Name:
Last Name:CALCAVECCHIO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ANTONINA
Other - Middle Name:LOUISE
Other - Last Name:CALCAVECCHIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:111 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-2517
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1617 N JAMES ST
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-2852
Practice Address - Country:US
Practice Address - Phone:315-336-8260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-12
Last Update Date:2025-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102209715207Q00000X
390200000X
NY328694207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program