Provider Demographics
NPI:1033117981
Name:CALLAHAN, CLAIBORNE MOORE (MD)
Entity Type:Individual
Prefix:DR
First Name:CLAIBORNE
Middle Name:MOORE
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CLAIBORNE
Other - Middle Name:HAYTHE
Other - Last Name:CALLAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:20 DAVIS AVE SW
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-3824
Mailing Address - Country:US
Mailing Address - Phone:703-777-1244
Mailing Address - Fax:540-338-9137
Practice Address - Street 1:20 DAVIS AVE SW
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-3824
Practice Address - Country:US
Practice Address - Phone:703-777-1244
Practice Address - Fax:540-338-9137
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2021-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101250311207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510I180004OtherMEDICARE PTAN
AL510I180004OtherMEDICARE PTAN