Provider Demographics
NPI:1851319768
Name:CALDERON-DUJARRIC, FERMIN (MD)
Entity type:Individual
Prefix:
First Name:FERMIN
Middle Name:
Last Name:CALDERON-DUJARRIC
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 1:490 E NORTH AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4741
Mailing Address - Country:US
Mailing Address - Phone:412-442-2505
Mailing Address - Fax:412-321-1627
Practice Address - Street 1:490 E NORTH AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4741
Practice Address - Country:US
Practice Address - Phone:412-442-2505
Practice Address - Fax:412-321-1627
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD446151207RI0200X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA106693196AMedicaid
OH0068116Medicaid
PA1027334960001Medicaid
WV3810023537Medicaid
PAP01152747Medicare PIN
PA1027334960001Medicaid
GAI12575Medicare UPIN
PA1027334960001Medicaid