Provider Demographics
NPI:1518968882
Name:CALLAHAN, MARY B (DO)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:B
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:25 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3129
Mailing Address - Country:US
Mailing Address - Phone:508-778-1829
Mailing Address - Fax:508-778-0113
Practice Address - Street 1:25 MAIN ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3129
Practice Address - Country:US
Practice Address - Phone:508-778-1829
Practice Address - Fax:508-778-0113
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA160179207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2675818OtherAETNA
MA3017490OtherNEIGHBORHOOD HEALTH
MA3200680Medicaid
MAJ21736OtherBLUE CROSS BLUE SHIELD
MA160179OtherTUFTS
MA000000024479OtherBMC HEALTHNET
MA1518968882OtherBOSTON MEDICAL CENTER
MA1518968882OtherUNICARE
11079014OtherCAQH
MA69586OtherHARVARD PILGRIM
MA160179OtherMA LICENSE
MA1518968882OtherMEDICARE ID
MA1518968882OtherHEALTH NET/ TRICARE NORTH
MAMC0380698GOtherMA CONTROLLED SUBSTANCE
MA0058769OtherCIGNA
MA04-00730OtherUNITED HEALTHCARE
MA04-00730OtherUNITED HEALTHCARE
MA000000024479OtherBMC HEALTHNET
MA04-00730OtherUNITED HEALTHCARE