Provider Demographics
NPI:1801056916
Name:CALHOUN, TINA M (DO)
Entity type:Individual
Prefix:DR
First Name:TINA
Middle Name:M
Last Name:CALHOUN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:TINA
Other - Middle Name:M
Other - Last Name:CASEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1605 N CEDAR CREST BLVD
Mailing Address - Street 2:SUITE 110B
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2351
Mailing Address - Country:US
Mailing Address - Phone:610-973-1410
Mailing Address - Fax:610-973-1449
Practice Address - Street 1:798 HAUSMAN RD
Practice Address - Street 2:SUITE 220
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-9108
Practice Address - Country:US
Practice Address - Phone:610-530-2290
Practice Address - Fax:484-403-4007
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS014905207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOS014905OtherSTATE LICENSE