Provider Demographics
NPI:1396737219
Name:CALVERT, HAROLD MILTON (MD)
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:MILTON
Last Name:CALVERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KEETON DR.
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240
Mailing Address - Country:US
Mailing Address - Phone:270-886-2050
Mailing Address - Fax:270-886-2007
Practice Address - Street 1:100 KEETON DR
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240
Practice Address - Country:US
Practice Address - Phone:270-886-2050
Practice Address - Fax:270-886-2007
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-0195207W00000X
KS04-28667207W00000X
TNMD0000035976207W00000X
KY36511207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64031669Medicaid
TN3879308Medicaid
KY7163Medicare ID - Type Unspecified
TN3879308Medicaid
KY64031669Medicaid