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General NPI Number Information
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NPI Number | 1013086404
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Entity Type | Organization
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Legal Business Name | JOHN M. CALLAHAN M.D. P.C.
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 212 HIGHBRIDGE ST SUITE C
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City | FAYETTEVILLE
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State | NY
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Zip | 13066-1979
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Country | US
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Telephone | 315-637-0477
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Fax |
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Provider Business Mailing Address
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Address Line | 212 HIGHBRIDGE ST SUITE C
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City | FAYETTEVILLE
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State | NY
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Zip | 13066-1979
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Country | US
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Telephone | 315-637-0477
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | JOHN MICHAEL CALLAHAN
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Credential | M.D.
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Telephone | 315-637-0477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 208546
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License Number State | NY
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