Healthcare Provider Details

I. General information

NPI: 1043217128
Provider Name (Legal Business Name): DOUGLAS NELSON CALLEN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 04/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S WATER ST
KITTANNING PA
16201-2437
US

IV. Provider business mailing address

200 S WATER ST
KITTANNING PA
16201-2437
US

V. Phone/Fax

Practice location:
  • Phone: 724-548-4455
  • Fax: 724-543-4491
Mailing address:
  • Phone: 724-548-4455
  • Fax: 724-543-4491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAT000075L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: