Provider Demographics
NPI:1720862329
Name:SMALL, CALVIN ROSS SR
Entity type:Individual
Prefix:MR
First Name:CALVIN
Middle Name:ROSS
Last Name:SMALL
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 G ST SW APT 817
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20024-3132
Mailing Address - Country:US
Mailing Address - Phone:202-641-4833
Mailing Address - Fax:
Practice Address - Street 1:301 G ST SW APT 610
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20024-3128
Practice Address - Country:US
Practice Address - Phone:202-641-4833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-23
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program