Provider Demographics
NPI:1962491779
Name:CALLAHAN, ROBERT S (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:CALLAHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:10 HEATHER LOFT CT
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-1400
Mailing Address - Country:US
Mailing Address - Phone:302-547-4992
Mailing Address - Fax:302-444-8491
Practice Address - Street 1:32 OMEGA DR
Practice Address - Street 2:BUILDING J
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2058
Practice Address - Country:US
Practice Address - Phone:302-731-0942
Practice Address - Fax:302-444-8491
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEC1-0008123207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEG02399R01Medicare PIN