Provider Demographics
NPI:1215985445
Name:O'NEIL-CALLAHAN, KRISTIN M (MD)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:M
Last Name:O'NEIL-CALLAHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:M
Other - Last Name:O'NEIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:147 MILK ST
Mailing Address - Street 2:PROVIDER ENROLLMENT - 9TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4806
Mailing Address - Country:US
Mailing Address - Phone:617-559-8374
Mailing Address - Fax:
Practice Address - Street 1:2 ESSEX DR
Practice Address - Street 2:INTERNAL MEDICINE
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2902
Practice Address - Country:US
Practice Address - Phone:978-532-2800
Practice Address - Fax:978-977-4492
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA214128207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA214128OtherTUFTS
MAJ25281OtherBLUE CROSS
MA4906511OtherCIGNA
MAAA8807OtherHARVARD PILGRIM
MA3574003OtherAETNA
MA0175111Medicaid
MA0027266OtherNEIGHBORHOOD HEALTH
MAAA8807OtherHARVARD PILGRIM
MAH67315Medicare UPIN