Provider Demographics
NPI:1083875223
Name:CALLAHAN, SIDNEY (DO)
Entity Type:Individual
Prefix:
First Name:SIDNEY
Middle Name:
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 GREEN VALLEY RD
Mailing Address - Street 2:#201
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7014
Mailing Address - Country:US
Mailing Address - Phone:336-378-1110
Mailing Address - Fax:336-378-9986
Practice Address - Street 1:719 GREEN VALLEY RD
Practice Address - Street 2:#201
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7014
Practice Address - Country:US
Practice Address - Phone:336-378-1110
Practice Address - Fax:336-378-9986
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS015363207V00000X
NC2012-01437207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology