Provider Demographics
NPI:1134144454
Name:MCCALLION, PATRICK GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:GEORGE
Last Name:MCCALLION
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 1:5565 GROSSMONT CENTER DR
Mailing Address - Street 2:BLDG 3 SUITE 101
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942
Mailing Address - Country:US
Mailing Address - Phone:619-464-3353
Mailing Address - Fax:619-464-6720
Practice Address - Street 1:5565 GROSSMONT CENTER DR
Practice Address - Street 2:BLDG 3 SUITE 101
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942
Practice Address - Country:US
Practice Address - Phone:619-464-3353
Practice Address - Fax:619-464-6720
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG64989207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG6989AOtherMEDICARE PTAN
CAF47854Medicare UPIN