Provider Demographics
NPI:1780926659
Name:CALONJE, MARIO A (MD)
Entity type:Individual
Prefix:DR
First Name:MARIO
Middle Name:A
Last Name:CALONJE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MARIO
Other - Middle Name:A
Other - Last Name:CALONJE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1834 UPPERLINE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-5548
Mailing Address - Country:US
Mailing Address - Phone:504-891-7330
Mailing Address - Fax:504-269-8612
Practice Address - Street 1:1834 UPPERLINE ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-5548
Practice Address - Country:US
Practice Address - Phone:504-891-7330
Practice Address - Fax:504-269-8612
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA008464174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist