Provider Demographics
NPI:1275505356
Name:CALLWOOD, KIM MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:MARIA
Last Name:CALLWOOD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 HOSPITAL DR, DEPT OF RADIOLOGY
Mailing Address - Street 2:
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1189
Mailing Address - Country:US
Mailing Address - Phone:301-618-3340
Mailing Address - Fax:
Practice Address - Street 1:3001 HOSPITAL DR, DEPT OF RADIOLOGY
Practice Address - Street 2:
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1189
Practice Address - Country:US
Practice Address - Phone:301-618-3340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00388972085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC039495100Medicaid
MD055200300Medicaid
MDJ062OtherB/C B/S
MDKA80OtherB/C B/S
MDCN2566Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MDCD4495Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MD434L113CMedicare ID - Type UnspecifiedLOCALITY/JURIS. CODE 01
DC2849OtherB/C B/S
MDJ062OtherB/C B/S
MDKA80OtherB/C B/S
MD055200300Medicaid