Healthcare Provider Details

I. General information

NPI: 1447581756
Provider Name (Legal Business Name): RONALD S CALLAHAM NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2010
Last Update Date: 01/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 BUTLER AVE
LANCASTER PA
17601-6313
US

IV. Provider business mailing address

5080 SPECTRUM DR SUITE 1200 WEST
ADDISON TX
75001-4648
US

V. Phone/Fax

Practice location:
  • Phone: 717-391-3087
  • Fax: 717-391-6752
Mailing address:
  • Phone: 972-364-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberVP003515B
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN269982L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: