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NPI Code Detail

MEDICARE: KELLY J CALLAHAN PA-C

MEDICARE: KELLY J CALLAHAN PA-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
1363A00000XPhysician Assistant015348NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1780952861
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY J CALLAHAN PA-C
Provider Business Mailing Address
First Line : 100 PARK ST
Second Line :
City : GLENS FALLS
State : NY
Zip : 12801-4447
Country : US
Telephone Number : 518-926-5924
Fax Number : 518-926-6983
Provider Business Practice Location Address
First Line : 100 PARK ST
Second Line :
City : GLENS FALLS
State : NY
Zip : 12801-4447
Country : US
Telephone Number : 518-926-5925
Fax Number : 518-926-5917
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2011
Last Update Date : 09/28/2022

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