Provider Demographics
NPI:1992841019
Name:ROBERT S. CALLAHAN, M.D., P.A.
Entity Type:Organization
Organization Name:ROBERT S. CALLAHAN, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:CALLAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-731-0942
Mailing Address - Street 1:665 CHURCHMANS RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-1918
Mailing Address - Country:US
Mailing Address - Phone:302-731-0942
Mailing Address - Fax:302-731-7100
Practice Address - Street 1:665 CHURCHMANS RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-1918
Practice Address - Country:US
Practice Address - Phone:302-731-0942
Practice Address - Fax:302-731-7100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0008123207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEG02399Medicare PIN