MEDICARE: DR. ALBERT JOSEPH CALLAHAN III 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
1	208000000X	Pediatrics Physician	216962	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295722239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALBERT JOSEPH CALLAHAN III M.D.

Provider Business Mailing Address
First Line	:	45 PORTER RD
Second Line	:
City	:	EAST LONGMEADOW
State	:	MA
Zip	:	01028-1353
Country	:	US
Telephone Number	:	413-525-1981
Fax Number	:

Provider Business Practice Location Address
First Line	:	373 PARK ST
Second Line	:
City	:	WEST SPRINGFIELD
State	:	MA
Zip	:	01089-3304
Country	:	US
Telephone Number	:	413-734-1001
Fax Number	:	413-736-4875

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	02/29/2012

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