Healthcare Provider Details

I. General information

NPI: 1205768934
Provider Name (Legal Business Name): LIAM CALLAHAN NRP
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 CHURCH ST
GARDINER ME
04345-2170
US

IV. Provider business mailing address

549 APPLETON RIDGE RD
APPLETON ME
04862-6641
US

V. Phone/Fax

Practice location:
  • Phone: 207-582-4535
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number33060
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: