Provider Demographics
NPI:1225112931
Name:CALLAHAN, TAD PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:TAD
Middle Name:PATRICK
Last Name:CALLAHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:210 S PALISADE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-5932
Mailing Address - Country:US
Mailing Address - Phone:805-922-0481
Mailing Address - Fax:805-925-5261
Practice Address - Street 1:210 S PALISADE DR STE 101
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5932
Practice Address - Country:US
Practice Address - Phone:805-922-0481
Practice Address - Fax:805-925-5261
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24996207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB217899OtherMEDICARE ID
CA00A249960Medicaid
CA00A249960Medicaid