Healthcare Provider Details

I. General information

NPI: 1790733194
Provider Name (Legal Business Name): SCOTT R CALLAHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVE. COMPLEX CARE ML 15005
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-3000
  • Fax: 513-636-5859
Mailing address:
  • Phone: 513-636-3000
  • Fax: 513-636-5859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.081004
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number35-08-1004
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: