Provider Demographics
NPI:1275071375
Name:MARTINA P CALLUM M.D., LLC
Entity Type:Organization
Organization Name:MARTINA P CALLUM M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTINA
Authorized Official - Middle Name:PRISCILLA
Authorized Official - Last Name:CALLUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-506-2618
Mailing Address - Street 1:1900 E NORTHERN PKWY STE 3A
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-2113
Mailing Address - Country:US
Mailing Address - Phone:240-506-2618
Mailing Address - Fax:
Practice Address - Street 1:1900 E NORTHERN PKWY STE 3A
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-2113
Practice Address - Country:US
Practice Address - Phone:240-506-2618
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD63603207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty