Healthcare Provider Details

I. General information

NPI: 1578736682
Provider Name (Legal Business Name): MARC ADDISON CALLENDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2008
Last Update Date: 12/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 MEDICAL PKWY
ANNAPOLIS MD
21401-3280
US

IV. Provider business mailing address

PO BOX 12622
BELFAST ME
04915-4017
US

V. Phone/Fax

Practice location:
  • Phone: 443-481-6968
  • Fax: 443-481-6322
Mailing address:
  • Phone: 443-481-6482
  • Fax: 443-481-6515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number21906
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: