Provider Demographics
NPI:1801841457
Name:CALLAGHAN, CHERYL M (MD)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:M
Last Name:CALLAGHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:500 S 11TH AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-4835
Mailing Address - Country:US
Mailing Address - Phone:208-233-8000
Mailing Address - Fax:208-233-2220
Practice Address - Street 1:500 S 11TH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-4835
Practice Address - Country:US
Practice Address - Phone:208-233-8000
Practice Address - Fax:208-233-2220
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM7272207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010003881OtherREGENCE BLUE SHIELD
ID805068600Medicaid
ID160043917OtherRAILROAD MEDICARE
ID76955OtherBLUE CROSS
IDG62510Medicare UPIN
ID805068600Medicaid