Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | A0001110 | MD |
Y | 213ES0000X | Sports Medicine | A0001110 | MD |
N | 2081S0010X | Sports Medicine | J3-0000776 | DE |
N | 213ES0000X | Sports Medicine | J3-0000776 | DE |
NPI | 1073166542 |
---|---|
Provider Name | Edith Callahan |
First Address | Baltimore, MD 21214-2657 |
Second Address | Timonium, MD 21093-5135 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2019 |
Last Update Date | 23/07/2019 |