1588799068 NPI number — DAVID JEROME CALLANAN BA, CSC-AD

Table of content: DAVID JEROME CALLANAN BA, CSC-AD (NPI 1588799068)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588799068 NPI number — DAVID JEROME CALLANAN BA, CSC-AD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CALLANAN
Provider First Name:
DAVID
Provider Middle Name:
JEROME
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BA, CSC-AD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588799068
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
717 CAMBERLEY CIR
Provider Second Line Business Mailing Address:
APARTMENT T-2
Provider Business Mailing Address City Name:
TOWSON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21204-3844
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-337-6995
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6401 YORK RD
Provider Second Line Business Practice Location Address:
3RD FLOOR
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21212-2152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-887-3828
Provider Business Practice Location Address Fax Number:
410-887-3786
Provider Enumeration Date:
02/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  SC1103 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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