Provider Demographics
NPI:1154390268
Name:MCCALLISTER, JOHN A (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:MCCALLISTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 E CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-5758
Mailing Address - Country:US
Mailing Address - Phone:207-623-2977
Mailing Address - Fax:207-626-9374
Practice Address - Street 1:6 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5758
Practice Address - Country:US
Practice Address - Phone:207-623-2977
Practice Address - Fax:207-626-9374
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036073147207RH0003X
ME018027208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036073147Medicaid
ILIL01T7OtherJOHN DEERE
IL07215036OtherBCBS
ME433395099Medicaid
ME433395099Medicaid
ILIL01T7OtherJOHN DEERE
ILB28054Medicare UPIN
ME001262502Medicare PIN