MEDICARE: EDWARD 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
1	237700000X	Hearing Instrument Specialist	302	CT

General Provider Information

NPI Number	:	1417323536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD CALLAHAN

Provider Business Mailing Address
First Line	:	1445 NEW BRITAIN AVE
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06110-1659
Country	:	US
Telephone Number	:	860-882-5621
Fax Number	:	860-882-5623

Provider Business Practice Location Address
First Line	:	1445 NEW BRITAIN AVE
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06110-1659
Country	:	US
Telephone Number	:	860-882-5621
Fax Number	:	860-882-5623

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

Provider Enumeration Date	:	08/12/2015
Last Update Date	:	08/12/2015

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Directions to “ EDWARD CALLAHAN ” Practice Location

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