Provider Demographics
NPI:1144243122
Name:CALLAHAN, DANIELLE M (PA)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:M
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 OAK GROVE LN
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-3728
Mailing Address - Country:US
Mailing Address - Phone:724-971-5002
Mailing Address - Fax:
Practice Address - Street 1:1600 BLACK ROCK RD
Practice Address - Street 2:
Practice Address - City:ROYERSFORD
Practice Address - State:PA
Practice Address - Zip Code:19468-3147
Practice Address - Country:US
Practice Address - Phone:724-971-5002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002310363A00000X
MA4977363A00000X
363AM0700X
PAMA053373363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical