Provider Demographics
NPI:1790787752
Name:CALLEN, DENNIS R (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:R
Last Name:CALLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1029
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02722-1029
Mailing Address - Country:US
Mailing Address - Phone:508-675-7819
Mailing Address - Fax:508-675-3822
Practice Address - Street 1:831 MAIN RD
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:MA
Practice Address - Zip Code:02790-4315
Practice Address - Country:US
Practice Address - Phone:508-636-0613
Practice Address - Fax:508-636-0616
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA48749207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2076667Medicaid
MAJ02060Medicare PIN
MA2076667Medicaid