Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 0101250311 | VA |
NPI | 1033117981 |
---|---|
Provider Name | Dr. Claiborne Moore Callahan |
First Address | Leesburg, VA 20175-3824 |
Second Address | Leesburg, VA 20175-3824 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2005 |
Last Update Date | 17/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
510I180004 | MEDICARE PTAN (01) | AL |
I22784 | (02) | AL |