Basic Information
Provider Information
NPI: 1790987386
EntityType: 2
ReplacementNPI:  
OrganizationName: THEODORE A CALIANOS II MD PC
LastName:  
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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
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208200000X157231MAY193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansPlastic Surgery 

ID Information
IDTypeStateIssuerDescription
15723101MATUFTSOTHER
152802181301MANPI 1OTHER
2130301MAHARVARD PILGRIM HEALTHCAROTHER
130006701MAUNITED HEALTH CAREOTHER
J1911801MABLUS CROSSOTHER


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