Provider Demographics
NPI:1255984704
Name:CALLAHAN, CHRISTINE (CNM)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3309 CANNONGATE RD APT 102
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4809
Mailing Address - Country:US
Mailing Address - Phone:301-875-6345
Mailing Address - Fax:
Practice Address - Street 1:3650 JOSEPH SIEWICK DR STE 203
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1712
Practice Address - Country:US
Practice Address - Phone:703-391-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024177655176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife