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NPI Code Detail

MEDICARE: DR. CLAIBORNE MOORE CALLAHAN M.D.

MEDICARE: DR. CLAIBORNE MOORE CALLAHAN M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207W00000XOphthalmology Physician0101250311VA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1510I180004OTHERALMEDICARE PTAN

General Provider Information

NPI Number : 1033117981
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CLAIBORNE MOORE CALLAHAN M.D.
Provider Business Mailing Address
First Line : 20 DAVIS AVE SW
Second Line :
City : LEESBURG
State : VA
Zip : 20175-3824
Country : US
Telephone Number : 703-777-1244
Fax Number : 540-338-9137
Provider Business Practice Location Address
First Line : 20 DAVIS AVE SW
Second Line :
City : LEESBURG
State : VA
Zip : 20175-3824
Country : US
Telephone Number : 703-777-1244
Fax Number : 540-338-9137
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2005
Last Update Date : 01/17/2021

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