Provider Demographics
NPI:1639043177
Name:CALHOUN, NIQCARDO
Entity type:Individual
Prefix:
First Name:NIQCARDO
Middle Name:
Last Name:CALHOUN
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 1:10000 LINCOLN DR E # 35274
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3108
Mailing Address - Country:US
Mailing Address - Phone:832-390-5479
Mailing Address - Fax:
Practice Address - Street 1:10000 LINCOLN DR E # 35274
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3108
Practice Address - Country:US
Practice Address - Phone:832-390-5479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-29
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ251X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage