MEDICARE: MARY ELIZABETH CALLAHAN P.A.

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	363AM0700X	Medical Physician Assistant	PA9107349	FL

General Provider Information

NPI Number	:	1841632304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ELIZABETH CALLAHAN P.A.

Provider Business Mailing Address
First Line	:	6101 BLUE LAGOON DR STE 200
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-3168
Country	:	US
Telephone Number	:	305-500-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	973 SE FEDERAL HWY STE 973B
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34994-3702
Country	:	US
Telephone Number	:	772-288-5897
Fax Number	:

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

Provider Enumeration Date	:	07/25/2013
Last Update Date	:	01/19/2024

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