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NPI Code Detail

MEDICARE: CORY CALLAHAN

MEDICARE: CORY CALLAHAN
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
11223G0001XGeneral Practice Dentistry17532MD

General Provider Information

NPI Number : 1073245551
Entity Type Code : Individual
Provider Name (Legal Business Name) : CORY CALLAHAN
Provider Business Mailing Address
First Line : 1703 WILLOW SPRINGS DR
Second Line :
City : SYKESVILLE
State : MD
Zip : 21784-5601
Country : US
Telephone Number : 443-844-6212
Fax Number :
Provider Business Practice Location Address
First Line : 5126 DORSEY HALL DR
Second Line :
City : ELLICOTT CITY
State : MD
Zip : 21042-7887
Country : US
Telephone Number : 410-740-9400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2022
Last Update Date : 06/24/2022

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Directions to “ CORY CALLAHAN ” Practice Location

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