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Individual
DR. MARY JO MILES CALEBAUGH
Active
Individual
DR. MARY JO MILES CALEBAUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
237412
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02711668
—
NY
01
—
06061121
ECFMG
—
Enumeration date
02/01/2006
Last updated
12/05/2012
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