Provider Demographics
NPI:1497944946
Name:CALLAHAN, GREGORY J (BOCO)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:J
Last Name:CALLAHAN
Suffix:
Gender:M
Credentials:BOCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 LOCH RAVEN BLVD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-2108
Mailing Address - Country:US
Mailing Address - Phone:410-605-7000
Mailing Address - Fax:410-605-7677
Practice Address - Street 1:3900 LOCH RAVEN BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-2108
Practice Address - Country:US
Practice Address - Phone:410-605-7000
Practice Address - Fax:410-605-7677
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC21679247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other