Basic Information
| Provider Information | |||||||||
| NPI: | 1386668341 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CALLAHAN | ||||||||
| FirstName: | DEBRA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3560 MERIDIAN ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982251731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607342800 | ||||||||
| FaxNumber: | 3607343818 | ||||||||
| Practice Location | |||||||||
| Address1: | 3614 MERIDIAN ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982251748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607342800 | ||||||||
| FaxNumber: | 3607343818 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 05/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZB0001X | S-04-006 | MI | N | Allopathic & Osteopathic Physicians | Pathology | Blood Banking & Transfusion Medicine | 207ZP0105X | 25155 | SC | Y | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology/Laboratory Medicine |
ID Information
| ID | Type | State | Issuer | Description | 122402 | 01 | AK | MEDICAL LICENSE | OTHER | T83120 | 05 | SC | MEDICAID | MD60357962 | 01 | WA | MEDICAL LICENSE | OTHER |