Provider Demographics
NPI:1295722239
Name:CALLAHAN, ALBERT JOSEPH III (MD)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:JOSEPH
Last Name:CALLAHAN
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:45 PORTER RD
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-1353
Mailing Address - Country:US
Mailing Address - Phone:413-525-1981
Mailing Address - Fax:
Practice Address - Street 1:373 PARK ST
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-3304
Practice Address - Country:US
Practice Address - Phone:413-734-1001
Practice Address - Fax:413-736-4875
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216962208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2019744Medicaid