Provider Demographics
NPI:1487256616
Name:CALABRESE, ANTIONE LEN
Entity type:Individual
Prefix:
First Name:ANTIONE
Middle Name:LEN
Last Name:CALABRESE
Suffix:
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 1:6426 STONEY PT S
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3910
Mailing Address - Country:US
Mailing Address - Phone:757-756-0133
Mailing Address - Fax:
Practice Address - Street 1:6426 STONEY PT S
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3910
Practice Address - Country:US
Practice Address - Phone:757-756-0133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT60566521172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver