Provider Demographics
NPI:1558556266
Name:KEITH L. CALLAHAN M.D., P.C.
Entity Type:Organization
Organization Name:KEITH L. CALLAHAN M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CALLAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-921-5672
Mailing Address - Street 1:390 TOLL GATE RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4326
Mailing Address - Country:US
Mailing Address - Phone:401-921-5672
Mailing Address - Fax:401-921-5679
Practice Address - Street 1:390 TOLL GATE RD
Practice Address - Street 2:SUITE 108
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4326
Practice Address - Country:US
Practice Address - Phone:401-921-5672
Practice Address - Fax:401-921-5679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI089005696Medicare PIN