Provider Demographics
NPI:1639137573
Name:CALLSEN, MARY ELIZABETH
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELIZABETH
Last Name:CALLSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 GREENLEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7315 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3202
Practice Address - Country:US
Practice Address - Phone:240-235-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0059499207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1588055OtherCIGNA PROVIDER NUMBER
MD5770131OtherAETNA PPO PROVIDER NUMBER
MD61813201OtherBSMD PROVIDER NUMBER
MD8127031OtherMDIPA PROVIDER NUMBER
MD9070 0013OtherBSDC PROVIDER NUMBER
MD8127031OtherOPTIMUM CHOICE PROVIDER #
MD100797OtherJHHC PROVIDER NUMBER
MD521186611OtherUNITED HEALTHCARE PROV #
MD8127031OtherALLIANCE PROVIDER NUMBER
MD5770131OtherAETNA HMO PROVIDER NUMBER
MD8127031OtherMAMSI PROVIDER NUMBER
MD5770131OtherAETNA PPO PROVIDER NUMBER
MDG10512Medicare UPIN