Healthcare Provider Details

I. General information

NPI: 1528098464
Provider Name (Legal Business Name): CECILIA CALLAHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 LOCH RAVEN BLVD
BALTIMORE MD
21239-2905
US

IV. Provider business mailing address

PO BOX 65033
BALTIMORE MD
21264-5033
US

V. Phone/Fax

Practice location:
  • Phone: 410-751-5028
  • Fax:
Mailing address:
  • Phone: 517-787-6440
  • Fax: 517-787-4146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberD0053472
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: