Healthcare Provider Details

I. General information

NPI: 1205880507
Provider Name (Legal Business Name): MAUREEN ANN CALLAGHAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 BRIDGEPORT WAY W
UNIVERSITY PLACE WA
98466-4614
US

IV. Provider business mailing address

2901 BRIDGEPORT WAY W
UNIVERSITY PLACE WA
98466-4614
US

V. Phone/Fax

Practice location:
  • Phone: 253-534-7000
  • Fax:
Mailing address:
  • Phone: 253-534-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084H0002X
TaxonomyHospice and Palliative Medicine (Psychiatry & Neurology) Physician
License NumberMD00020274
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD00020274
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberMD00020274
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: