Provider Demographics
NPI:1578782066
Name:CHARLES D. CALLERY, M.D., INC
Entity Type:Organization
Organization Name:CHARLES D. CALLERY, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:CALLERY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-675-0883
Mailing Address - Street 1:15725 POMERADO RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2068
Mailing Address - Country:US
Mailing Address - Phone:858-675-0883
Mailing Address - Fax:858-675-0549
Practice Address - Street 1:15725 POMERADO RD
Practice Address - Street 2:SUITE 206
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2068
Practice Address - Country:US
Practice Address - Phone:858-675-0883
Practice Address - Fax:858-675-0549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG33540261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA45584Medicare UPIN