Scott B Callahan, PA-C
Individual provider Active NPI Surgical Physician Assistant · Derby, CT
NPI 1205892452 · NPPES record last updated Jan 7, 2008
Key facts
- NPI
- 1205892452
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgical Physician Assistant 363AS0400X
- License
- 0522 (NH)
- Practice address
- 130 Division St
Derby, CT 06418-1326 - Phone
- (203) 735-7421
- NPI assigned
- Apr 25, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001184 | CT | MD | Mental Health Counselor |
| 0522 | NH | MD | Surgical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bridgeport Hospital | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | 0522 | NH | Yes |
Addresses
Primary practice location
130 Division St
Derby, CT 06418-1326
Mailing address
301 Leavenworth Rd
Shelton, CT 06484-1841
Phone (203) 513-2127
Other providers in Derby, CT
- Katherine N Bunger
- Thommy Josue Bustillo
- Laura Butler
- Diana Bytyqi
- Wilfredo Cadelina
- Amber L Cammarata
- Amber Canavan
- Alexis Cardinali
- Cardiology Associates of Derby PC
- Alexander A Carrese
All providers in Derby, CT · Surgical Physician Assistant in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 7, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.