Basic Information
| Provider Information | |||||||||
| NPI: | 1356331847 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CALCAGNO | ||||||||
| FirstName: | FRANK | ||||||||
| MiddleName: | ANTHONY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24850 SE STARK ST | ||||||||
| Address2: | STE 150 | ||||||||
| City: | GRESHAM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970308316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034910714 | ||||||||
| FaxNumber: | 5036742834 | ||||||||
| Practice Location | |||||||||
| Address1: | 24850 SE STARK ST | ||||||||
| Address2: | STE 150 | ||||||||
| City: | GRESHAM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970308316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034910714 | ||||||||
| FaxNumber: | 5036742834 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2005 | ||||||||
| LastUpdateDate: | 04/12/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MD21612 | OR | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 130258 | 05 | OR | MEDICAID |