MEDICARE: KEITH L 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
1	207Q00000X	Family Medicine Physician	MD12303	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9201212	OTHER	RI	CIGNA
2	496-667	OTHER	RI	TUFTS
3	AA98861	OTHER	RI	HARVARD PILGRIM
4	32250-6	OTHER	RI	BLUE CROSS
5	414283	OTHER	RI	BLUE CHIP
6	810900591	OTHER	RI	MULTIPLAN/PHCS

General Provider Information

NPI Number	:	1629063219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITH L CALLAHAN M.D.

Provider Business Mailing Address
First Line	:	390 TOLL GATE RD
Second Line	:	SUITE 108
City	:	WARWICK
State	:	RI
Zip	:	02886-4326
Country	:	US
Telephone Number	:	401-921-5672
Fax Number	:	401-921-5679

Provider Business Practice Location Address
First Line	:	390 TOLL GATE RD
Second Line	:	SUITE 108
City	:	WARWICK
State	:	RI
Zip	:	02886-4326
Country	:	US
Telephone Number	:	401-921-5672
Fax Number	:	401-921-5679

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

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	04/29/2026

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Directions to “ KEITH L CALLAHAN M.D.” Practice Location

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