Provider Demographics
NPI:1376682450
Name:CALLAHAN, KATHLEEN (RD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 HARVARD RD
Mailing Address - Street 2:
Mailing Address - City:WATERVLIET
Mailing Address - State:NY
Mailing Address - Zip Code:12189-1212
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:47 NEW SCOTLAND AVE
Practice Address - Street 2:ALBANY MEDICAL CENTER HOSPITAL
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3412
Practice Address - Country:US
Practice Address - Phone:518-262-0942
Practice Address - Fax:518-262-6081
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10068934OtherCDPHP
NY4124267OtherMVP HEALTH PLAN