1124082912 NPI number — DR. KELLIANN DIGNAM KALLAUR OD, FAAO

Table of content: DR. KELLIANN DIGNAM KALLAUR OD, FAAO (NPI 1124082912)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124082912 NPI number — DR. KELLIANN DIGNAM KALLAUR OD, FAAO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KALLAUR
Provider First Name:
KELLIANN
Provider Middle Name:
DIGNAM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD, FAAO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KALLAUR
Provider Other First Name:
KELLIANN
Provider Other Middle Name:
DIGNAM
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
OD, FAAO
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1124082912
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2131 FOLKSTONE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TIMONIUM
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21093-3312
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-895-0720
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 N GREENE ST
Provider Second Line Business Practice Location Address:
DEPARTMENT OF VETERANS AFFAIRS, VA EYE CLINIC
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21201-1524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-605-7230
Provider Business Practice Location Address Fax Number:
410-605-7232
Provider Enumeration Date:
04/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  TA 1511 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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