Provider Demographics
NPI:1750623252
Name:MCCALLA, DAREN J (MD)
Entity type:Individual
Prefix:DR
First Name:DAREN
Middle Name:J
Last Name:MCCALLA
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:STONY BROOK MEDICINE HSC T18 ROOM 020
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8181
Mailing Address - Country:US
Mailing Address - Phone:631-444-2632
Mailing Address - Fax:631-444-7671
Practice Address - Street 1:STONY BROOK MEDICINE HSC T18 ROOM 020
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8181
Practice Address - Country:US
Practice Address - Phone:631-444-2632
Practice Address - Fax:631-444-7671
Is Sole Proprietor?:No
Enumeration Date:2013-03-22
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY315563207XS0117X
TXS3421207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine