Provider Demographics
NPI:1811071012
Name:CALLAHAN BUTLER, SHEILA M (MD)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:M
Last Name:CALLAHAN BUTLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 CHANDLER STREET
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01602
Mailing Address - Country:US
Mailing Address - Phone:508-767-3992
Mailing Address - Fax:508-767-3999
Practice Address - Street 1:372 CHANDLER STREET
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01602
Practice Address - Country:US
Practice Address - Phone:508-767-3992
Practice Address - Fax:508-767-3999
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA53989208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
J04204OtherBLUE CROSS
MA6189652Medicaid
J04204OtherBLUE CROSS