Individual
CHARLES CALLAHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
593 EDDY ST, CLAVERICK 2, PROVIDENCE, RI 02903-4923
(401) 854-2504
(401) 854-2519
Mailing address
PO BOX 9484, PROVIDENCE, RI 02940-9484
(401) 854-2500
(401) 854-2519
Taxonomy
Speciality
Code
Description
License number
State
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
Primary
MD10524
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007008870
RI MEDICARE
RI
01
—
01-27-2009
TUFTS HEALTH PLAN
MA
01
—
01/27/2009
TUFTS
RI
01
—
04/15/2009
UNITED HEALTHCARE
RI
01
—
12/14/2006
NHPRI
RI
01
—
1477577302
NPI
RI
05
—
3156567
—
MA
01
—
408343
BCBSRI
RI
01
—
939025129
RI MEDICARE GROUP NUMBER
RI
05
—
CC23905
—
RI
Enumeration date
07/26/2006
Last updated
09/17/2013
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