1326163528 NPI number — ROBERT W. KALISH, M.D., LTD

Table of content: (NPI 1326163528)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326163528 NPI number — ROBERT W. KALISH, M.D., LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT W. KALISH, M.D., LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326163528
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2450 OLD FORTY FOOT RD
Provider Second Line Business Mailing Address:
P.O. BOX 178
Provider Business Mailing Address City Name:
SKIPPACK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19474-0178
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-222-0446
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2450 OLD FORTY FOOT RD
Provider Second Line Business Practice Location Address:
BOX 178
Provider Business Practice Location Address City Name:
SKIPPACK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19474-0178
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-222-0446
Provider Business Practice Location Address Fax Number:
610-222-4101
Provider Enumeration Date:
03/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KALISH
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
W
Authorized Official Title or Position:
OWNER OPERATOR
Authorized Official Telephone Number:
610-222-0446

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  MD029379L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 176269821 . This is a "UNITED BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 260010475 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 18538 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 004325 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0046269000 . This is a "PERSONAL CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0046269000 . This is a "KEYSTONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 245004000 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".




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