Provider Demographics
NPI:1063681583
Name:PATRICE CALLAHAN MD PA
Entity Type:Organization
Organization Name:PATRICE CALLAHAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:O'NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-365-0655
Mailing Address - Street 1:5741 BEE RIDGE RD
Mailing Address - Street 2:SUITE 280
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-5064
Mailing Address - Country:US
Mailing Address - Phone:941-365-0655
Mailing Address - Fax:
Practice Address - Street 1:5741 BEE RIDGE RD
Practice Address - Street 2:SUITE 280
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-5064
Practice Address - Country:US
Practice Address - Phone:941-365-0655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL44766ZMedicare PIN