Healthcare Provider Details

I. General information

NPI: 1245610492
Provider Name (Legal Business Name): DAWN PAULINE CALLAHAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2015
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1-2 HONCHO, 1-CHOME
YOKOSUKA KANAGAWA
2380001
JP

IV. Provider business mailing address

PSC 475 BOX 1537
FPO AP
96350-1537
US

V. Phone/Fax

Practice location:
  • Phone: 315-243-8721
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101262801
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: