Provider Demographics
NPI:1023004520
Name:CALLAHAN, THOMAS DANIEL V (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:DANIEL
Last Name:CALLAHAN
Suffix:V
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 W CREEK RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2139
Mailing Address - Country:US
Mailing Address - Phone:800-223-2273
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:800-223-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35082810207R00000X, 207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPENDINGOtherSUMMA CARE
OHPENDINGOtherQUALCHOICE
OHPENDINGOtherUNITED HEALTH CARE
OHPENDINGOtherKAISER
OHPENDINGOtherBWC
OHPENDINGOtherANTHEM
OHPENDINGOtherRAILROAD MEDICARE
OHPENDINGOtherCARESOURCE
OHPENDINGOtherTRICARE
OH2472015Medicaid
OHPENDINGOtherANTHEM
OHPENDINGOtherCARESOURCE
OH7386261Medicare PIN