Provider Demographics
NPI:1821000407
Name:CALLUM, MARTINA PRISCILLA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTINA
Middle Name:PRISCILLA
Last Name:CALLUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-4833
Mailing Address - Country:US
Mailing Address - Phone:410-323-7917
Mailing Address - Fax:
Practice Address - Street 1:708 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-4833
Practice Address - Country:US
Practice Address - Phone:410-323-7917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063603174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist