Provider Demographics
NPI:1194811828
Name:CALLAHAN, SEAN PATRICK (MD)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:PATRICK
Last Name:CALLAHAN
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 1:11697 W STATE ROUTE 163
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:OH
Mailing Address - Zip Code:43449
Mailing Address - Country:US
Mailing Address - Phone:419-898-0993
Mailing Address - Fax:419-898-2444
Practice Address - Street 1:11697 W STATE ROUTE 163
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:OH
Practice Address - Zip Code:43449
Practice Address - Country:US
Practice Address - Phone:419-898-0993
Practice Address - Fax:419-898-2444
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-07-4846207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2084784Medicaid
OH174384OtherANTHEM BCBS OF OHIO
OH174384OtherANTHEM BCBS OF OHIO
OHG93095Medicare UPIN
OH2084784Medicaid