Healthcare Provider Details

I. General information

NPI: 1588718605
Provider Name (Legal Business Name): CLARA A. CALLAHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JEF FACULTY PEDS AND DUPONT CHILDRENS HLTH PROG 833 CHESTNUT STREET EAST SUITE 300
PHILADELPHIA PA
19107-4413
US

IV. Provider business mailing address

NEMOURS CHILDRENS CLINIC P.O. BOX 404112
ATLANTA GA
30384-0001
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-7800
  • Fax: 215-923-9383
Mailing address:
  • Phone: 904-390-3610
  • Fax: 904-288-5890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD021793E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD021793E
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD021793E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: