Provider Demographics
NPI:1730122425
Name:CALLAHAN, MICHAEL E (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:E
Last Name:CALLAHAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:GALETON
Mailing Address - State:PA
Mailing Address - Zip Code:16922-1203
Mailing Address - Country:US
Mailing Address - Phone:814-435-2942
Mailing Address - Fax:
Practice Address - Street 1:30 RIVER ST
Practice Address - Street 2:
Practice Address - City:GALETON
Practice Address - State:PA
Practice Address - Zip Code:16922-1203
Practice Address - Country:US
Practice Address - Phone:814-435-2942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS002956L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC30617Medicare UPIN
PA117880Medicare ID - Type Unspecified