Provider Demographics
NPI:1447353024
Name:CALDERWOOD, MARK ALEXANDER (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ALEXANDER
Last Name:CALDERWOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1200 WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-2345
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 N 10TH ST STE A
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-5322
Practice Address - Country:US
Practice Address - Phone:406-363-5434
Practice Address - Fax:406-363-5210
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-PHYS-LIC-7129207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT100029272Medicaid
ID1447353024Medicaid
MT1447353024Medicaid
MT011000223Medicare PIN
G73476Medicare UPIN