Provider Demographics
NPI:1568454528
Name:CALLAHAN, JOHN M (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:M
Last Name:CALLAHAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:301 PROSPECT AVE
Mailing Address - Street 2:HOSPITAL INTERNISTS
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-1807
Mailing Address - Country:US
Mailing Address - Phone:315-448-5704
Mailing Address - Fax:315-423-6853
Practice Address - Street 1:301 PROSPECT AVE
Practice Address - Street 2:HOSPITAL INTERNISTS
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-1807
Practice Address - Country:US
Practice Address - Phone:315-448-5704
Practice Address - Fax:315-423-6853
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2013-04-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY208546207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00927986OtherRAILROAD MEDICARE PTAN
NY01936736Medicaid
NYBA0993Medicare PIN
NY01936736Medicaid