Henry Calderoni, MD
Individual provider Active NPI Family Medicine Physician · Santa Teresa, NM
NPI 1861483083 · NPPES record last updated Jun 15, 2016
Key facts
- NPI
- 1861483083
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 80-18 (NM)
- Practice address
- 5055 McNutt Rd
Santa Teresa, NM 88008-9442 - Phone
- (575) 589-5005
- Fax
- (575) 589-1333
- NPI assigned
- Nov 4, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 80-18 | NM | MD | Family Medicine Physician |
| F8430 | TX | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gary Grindstaff Dpmpa | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | F8430 | TX | |
| Family Medicine Physician | 207Q00000X | 80-18 | NM | Yes |
Addresses
Primary practice location
5055 McNutt Rd
Santa Teresa, NM 88008-9442
Mailing address
5055 McNutt Rd
Santa Teresa, NM 88008-9442
Phone (575) 589-5005
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000G6207 | Medicaid | NM | |
| 115519404 | Medicaid | TX | |
| 476935ZS5H | Other | NM | WELLMED PTAN |
| 080166729 | Other | TX | PALMETTO GBA |
| 908609J10 | Medicaid | TX |
Other providers in Santa Teresa, NM
- Buen Salud Inc
- Yadira Bueno
- Maria Lourdes Burciaga
- Anabel Bustos
- Ricardo Cadena Jr.
- Gabriela Cangas
- Jessica Michelle Cano
- Stephanie A Capshaw
- Ami Carmona
- Mia Carmona
All providers in Santa Teresa, NM · Family Medicine Physician in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 15, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.