| Doctor Name: | DR. JOHN P MACCALLUM |
| NPI Number: | 1134101389 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 10552 |
| Business Practice Address: | 4605 Maccorkle Ave Sw South Charleston, WV - 253091311 |
| Business Phone Number: | 3044144800 |
| Business Fax Number: | |
| Mailing Address: | # L3539, COLUMBUS |
| State: | OH |
| Postal Code: | 432600001 |
| Phone Number: | 3044144800 |
| Fax Number: | 3044144801 |
| NPI Enumeration Date: | 11/15/2005 |
| NPI Last Update Date: | 01/13/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 10552 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WV |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |