MEDICARE: DR. MARY ELIZABETH CALLSEN

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	207R00000X	Internal Medicine Physician	D0059499	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1588055	OTHER	MD	CIGNA PROVIDER NUMBER
2	5770131	OTHER	MD	AETNA PPO PROVIDER NUMBER
3	61813201	OTHER	MD	BSMD PROVIDER NUMBER
4	8127031	OTHER	MD	MDIPA PROVIDER NUMBER
5	9070 0013	OTHER	MD	BSDC PROVIDER NUMBER
6	8127031	OTHER	MD	OPTIMUM CHOICE PROVIDER #
7	100797	OTHER	MD	JHHC PROVIDER NUMBER
8	521186611	OTHER	MD	UNITED HEALTHCARE PROV #
9	8127031	OTHER	MD	ALLIANCE PROVIDER NUMBER
10	5770131	OTHER	MD	AETNA HMO PROVIDER NUMBER
11	8127031	OTHER	MD	MAMSI PROVIDER NUMBER

General Provider Information

NPI Number	:	1639137573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY ELIZABETH CALLSEN

Provider Business Mailing Address
First Line	:	6201 GREENLEIGH AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21220-2004
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7315 WISCONSIN AVE
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20814-3202
Country	:	US
Telephone Number	:	240-235-9100
Fax Number	:

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

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	01/27/2023

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