Provider Demographics
NPI:1295115889
Name:CALLAHAN, TRACY (PA)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:PEARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:680 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-3308
Mailing Address - Country:US
Mailing Address - Phone:508-894-0400
Mailing Address - Fax:508-894-0332
Practice Address - Street 1:286 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-1763
Practice Address - Country:US
Practice Address - Phone:781-341-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-09
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant