Basic Information
Provider Information | |||||||||
NPI: | 1790987386 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | THEODORE A CALIANOS II MD PC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 5 INDUSTRIAL DR | ||||||||
Address2: | SUITE 109 | ||||||||
City: | MASHPEE | ||||||||
State: | MA | ||||||||
PostalCode: | 02649 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5085396249 | ||||||||
FaxNumber: | 5085396223 | ||||||||
Practice Location | |||||||||
Address1: | 5 INDUSTRIAL DR | ||||||||
Address2: | SUITE 109 | ||||||||
City: | MASHPEE | ||||||||
State: | MA | ||||||||
PostalCode: | 02649 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5085396249 | ||||||||
FaxNumber: | 5085396223 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/05/2007 | ||||||||
LastUpdateDate: | 08/22/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | CALIANOS | ||||||||
AuthorizedOfficialFirstName: | THEODORE | ||||||||
AuthorizedOfficialMiddleName: | ARTHUR | ||||||||
AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
AuthorizedOfficialTelephone: | 5085396249 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: | II | ||||||||
AuthorizedOfficialCredential: | MD | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208200000X | 157231 | MA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Plastic Surgery |   |
ID Information
ID | Type | State | Issuer | Description | 157231 | 01 | MA | TUFTS | OTHER | 1528021813 | 01 | MA | NPI 1 | OTHER | 21303 | 01 | MA | HARVARD PILGRIM HEALTHCAR | OTHER | 1300067 | 01 | MA | UNITED HEALTH CARE | OTHER | J19118 | 01 | MA | BLUS CROSS | OTHER |