Healthcare Provider Details

I. General information

NPI: 1023180890
Provider Name (Legal Business Name): MARK GERARD O'CALLAGHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 04/28/2021
Certification Date: 04/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 MARTIN LUTHER KING JR WAY
TACOMA WA
98405-4265
US

IV. Provider business mailing address

TACOMA MEDICAL CENTER 209 MARTIN LUTHER KING JR. WAY
TACOMA WA
98405
US

V. Phone/Fax

Practice location:
  • Phone: 253-596-3300
  • Fax:
Mailing address:
  • Phone: 253-596-3300
  • Fax: 253-596-3301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberMD00047091
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: