Basic Information
Provider Information
NPI: 1336678580
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CALHOUN
FirstName: ELISABETH
MiddleName: ANNE
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1648 HUNTINGDON PIKE
Address2: MEDICAL STAFF OFFICE 1ST FLR
City: PHILADELPHIA
State: PA
PostalCode: 190468001
CountryCode: US
TelephoneNumber: 2159383450
FaxNumber: 2159383829
Practice Location
Address1: 1648 HUNTINGDON PIKE
Address2:  
City: MEADOWBROOK
State: PA
PostalCode: 190468001
CountryCode: US
TelephoneNumber: 2159382100
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/09/2017
LastUpdateDate: 07/29/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/29/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000XMD468764PAY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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