Healthcare Provider Details

I. General information

NPI: 1548833577
Provider Name (Legal Business Name): SETH WILLIAM CALLAHAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4051 OGLETOWN RD STE 103
NEWARK DE
19713-3101
US

IV. Provider business mailing address

211 EXECUTIVE DR STE 11
NEWARK DE
19702-3358
US

V. Phone/Fax

Practice location:
  • Phone: 302-731-2888
  • Fax: 302-731-7049
Mailing address:
  • Phone: 302-731-2888
  • Fax: 302-368-7756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: