Basic Information
| Provider Information | |||||||||
| NPI: | 1588718605 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CALLAHAN | ||||||||
| FirstName: | CLARA | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | NEMOURS CHILDRENS CLINIC | ||||||||
| Address2: | P.O. BOX 404112 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303840001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043903610 | ||||||||
| FaxNumber: | 9042885890 | ||||||||
| Practice Location | |||||||||
| Address1: | JEF FACULTY PEDS AND DUPONT CHILDRENS HLTH PROG | ||||||||
| Address2: | 833 CHESTNUT STREET EAST SUITE 300 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191074413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159557800 | ||||||||
| FaxNumber: | 2159239383 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2007 | ||||||||
| LastUpdateDate: | 05/02/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MD021793E | PA | N | Allopathic & Osteopathic Physicians | Pediatrics | 208D00000X | MD021793E | PA | Y | Allopathic & Osteopathic Physicians | General Practice | 208M00000X | MD021793E | PA | N | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 000860227 | 05 | PA | MEDICAID | 3774440 | 05 | NJ | MEDICAID | 4098072 | 05 | MD | MEDICAID |