Healthcare Provider Details

I. General information

NPI: 1295823557
Provider Name (Legal Business Name): CHARLES WILLIS CALLAHAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WALTER REED ARMY MEDICAL CENTER
WASHINGTON DC
20907-1234
US

IV. Provider business mailing address

13104 COLLINGWOOD TERRACE
SILVER SPRING MD
20904-1234
US

V. Phone/Fax

Practice location:
  • Phone: 202-782-8397
  • Fax: 202-782-4914
Mailing address:
  • Phone: 202-782-8397
  • Fax: 202-782-4914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberDOS719
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: