Provider Demographics
NPI:1750389854
Name:KALDAWY, ROGER M
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:M
Last Name:KALDAWY
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 1:160 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-3293
Mailing Address - Country:US
Mailing Address - Phone:508-473-7939
Mailing Address - Fax:508-473-3932
Practice Address - Street 1:160 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-3293
Practice Address - Country:US
Practice Address - Phone:085-473-7939
Practice Address - Fax:508-473-3932
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209960207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0135721Medicaid
G39667Medicare UPIN
MA0135721Medicaid