Provider Demographics
NPI:1386733988
Name:O'CALLAHAN, PATRICK (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:
Last Name:O'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 1:300 S HARBOR BLVD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-3733
Mailing Address - Country:US
Mailing Address - Phone:714-978-7488
Mailing Address - Fax:860-516-2883
Practice Address - Street 1:107 WILCOX RD
Practice Address - Street 2:SUITE 105
Practice Address - City:STONINGTON
Practice Address - State:CT
Practice Address - Zip Code:06378-2614
Practice Address - Country:US
Practice Address - Phone:650-380-4395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC534892083P0500X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
060646704OtherTRI-CARE
060646704OtherTRI-CARE
CTP00029345Medicare ID - Type UnspecifiedRAILROAD