Provider Demographics
NPI:1720632839
Name:VICTOR, CALVERT (MA)
Entity Type:Individual
Prefix:
First Name:CALVERT
Middle Name:
Last Name:VICTOR
Suffix:
Gender:M
Credentials:MA
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Mailing Address - Street 1:221 SW CHAPMAN AVE
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-4328
Mailing Address - Country:US
Mailing Address - Phone:724-752-2033
Mailing Address - Fax:772-207-5467
Practice Address - Street 1:221 SW CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-4328
Practice Address - Country:US
Practice Address - Phone:724-752-2033
Practice Address - Fax:772-207-5467
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-26
Last Update Date:2019-07-26
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy