Healthcare Provider Details

I. General information

NPI: 1083875223
Provider Name (Legal Business Name): SIDNEY CALLAHAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2008
Last Update Date: 08/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 GREEN VALLEY RD #201
GREENSBORO NC
27408-7014
US

IV. Provider business mailing address

719 GREEN VALLEY RD #201
GREENSBORO NC
27408-7014
US

V. Phone/Fax

Practice location:
  • Phone: 336-378-1110
  • Fax: 336-378-9986
Mailing address:
  • Phone: 336-378-1110
  • Fax: 336-378-9986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberOS015363
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2012-01437
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: