Healthcare Provider Details

I. General information

NPI: 1073439196
Provider Name (Legal Business Name): JEREMY CALLAHAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 OAK ST
PITTSTON PA
18640-3798
US

IV. Provider business mailing address

433 PLYMOUTH AVE
HANOVER TOWNSHIP PA
18706-5478
US

V. Phone/Fax

Practice location:
  • Phone: 570-808-9800
  • Fax:
Mailing address:
  • Phone: 570-574-3645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA067883
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: