Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MT212530 | PA |
N | 111NI0900X | Internist | MT212530 | PA |
Y | 2080P0208X | Pediatric Infectious Diseases | MT212530 | PA |
NPI | 1063642627 |
---|---|
Provider Name | Dr. Kevin P O'callaghan |
First Address | Philadelphia, PA 19104-4319 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2009 |
Last Update Date | 06/06/2017 |