Provider Demographics
NPI:1396703583
Name:KALONAROS, GEORGE CONSTANTINE (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:CONSTANTINE
Last Name:KALONAROS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2950 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-1304
Mailing Address - Country:US
Mailing Address - Phone:716-447-7260
Mailing Address - Fax:716-447-7263
Practice Address - Street 1:2950 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-1304
Practice Address - Country:US
Practice Address - Phone:716-447-7260
Practice Address - Fax:716-447-7263
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1552262084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01122774Medicaid
NY0509854OtherINDEPENDENT HEALTH
NY130011312OtherRAILROAD MEDICARE
NY00010086901OtherUNIVERA
NY000529289001OtherBLUE CROSS
NY0509854OtherINDEPENDENT HEALTH
NYE41736Medicare UPIN