MEDICARE: KEITH L. CALLAHAN M.D., P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center		RI

General Provider Information

NPI Number	:	1558556266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEITH L. CALLAHAN M.D., P.C.

Provider Business Mailing Address
First Line	:	390 TOLL GATE RD STE 108
Second Line	:
City	:	WARWICK
State	:	RI
Zip	:	02886-4326
Country	:	US
Telephone Number	:	401-921-5672
Fax Number	:	401-921-5679

Provider Business Practice Location Address
First Line	:	390 TOLL GATE RD STE 108
Second Line	:
City	:	WARWICK
State	:	RI
Zip	:	02886-4326
Country	:	US
Telephone Number	:	401-921-5672
Fax Number	:	401-921-5679

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KEITH LEE CALLAHAN
Credential	:	M.D.
Telephone Number	:	401-921-5672

Provider Enumeration Date	:	09/06/2007
Last Update Date	:	04/20/2026

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