Provider Demographics
NPI:1114189651
Name:MCCALLISTER, STEVEN SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:SCOTT
Last Name:MCCALLISTER
Suffix:
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 1:5 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-8219
Mailing Address - Country:US
Mailing Address - Phone:617-744-0178
Mailing Address - Fax:
Practice Address - Street 1:134 COOLIDGE AVE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-2815
Practice Address - Country:US
Practice Address - Phone:617-779-5514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039164207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
F73678Medicare UPIN