Basic Information
| Provider Information | |||||||||
| NPI: | 1578925558 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CALVO FRAGACHAN | ||||||||
| FirstName: | LUIS | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CALVO FRAGACHAN | ||||||||
| OtherFirstName: | LUIS | ||||||||
| OtherMiddleName: | MIGUEL | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 454 PEWTER CT APT 405 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229118474 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165142631 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2215 LANDOVER PL | ||||||||
| Address2: | |||||||||
| City: | LYNCHBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245012115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349473944 | ||||||||
| FaxNumber: | 4345442337 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2016 | ||||||||
| LastUpdateDate: | 10/19/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0101267924 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.