Provider Demographics
NPI:1699716183
Name:CALDERON, STEPHEN F (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:F
Last Name:CALDERON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 COTTAGE GROVE RD STE E010
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-4224
Mailing Address - Country:US
Mailing Address - Phone:860-241-4835
Mailing Address - Fax:860-244-3516
Practice Address - Street 1:701 COTTAGE GROVE RD STE E010
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-4224
Practice Address - Country:US
Practice Address - Phone:860-241-4835
Practice Address - Fax:860-244-3516
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT028908174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004001442Medicaid