Provider Demographics
NPI:1982671723
Name:CALLIS, STEWART JAMES (MD)
Entity Type:Individual
Prefix:MR
First Name:STEWART
Middle Name:JAMES
Last Name:CALLIS
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 1:317 E OAK ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21550
Mailing Address - Country:US
Mailing Address - Phone:301-334-5281
Mailing Address - Fax:301-334-2535
Practice Address - Street 1:317 E OAK ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550
Practice Address - Country:US
Practice Address - Phone:301-334-5281
Practice Address - Fax:301-334-2535
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD355772084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD466L323CMedicare PIN
MDA72658Medicare UPIN