=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588718605
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CLARA A. CALLAHAN MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2007
-----------------------------------------------------
Last Update Date | 05/02/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | JEF FACULTY PEDS AND DUPONT CHILDRENS HLTH PROG 833 CHESTNUT STREET EAST SUITE 300
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19107-4413
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-955-7800
-----------------------------------------------------
Fax | 215-923-9383
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | NEMOURS CHILDRENS CLINIC P.O. BOX 404112
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30384-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-390-3610
-----------------------------------------------------
Fax | 904-288-5890
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | MD021793E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | MD021793E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number | MD021793E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------