Healthcare Provider Details

I. General information

NPI: 1295722239
Provider Name (Legal Business Name): ALBERT JOSEPH CALLAHAN III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 02/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

373 PARK ST
WEST SPRINGFIELD MA
01089-3304
US

IV. Provider business mailing address

45 PORTER RD
EAST LONGMEADOW MA
01028-1353
US

V. Phone/Fax

Practice location:
  • Phone: 413-734-1001
  • Fax: 413-736-4875
Mailing address:
  • Phone: 413-525-1981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number216962
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: