Provider Demographics
NPI:1326163528
Name:ROBERT W. KALISH, M.D., LTD
Entity Type:Organization
Organization Name:ROBERT W. KALISH, M.D., LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:KALISH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-222-0446
Mailing Address - Street 1:2450 OLD FORTY FOOT RD
Mailing Address - Street 2:P.O. BOX 178
Mailing Address - City:SKIPPACK
Mailing Address - State:PA
Mailing Address - Zip Code:19474-0178
Mailing Address - Country:US
Mailing Address - Phone:610-222-0446
Mailing Address - Fax:
Practice Address - Street 1:2450 OLD FORTY FOOT RD
Practice Address - Street 2:BOX 178
Practice Address - City:SKIPPACK
Practice Address - State:PA
Practice Address - Zip Code:19474-0178
Practice Address - Country:US
Practice Address - Phone:610-222-0446
Practice Address - Fax:610-222-4101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029379L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
176269821OtherUNITED BEHAVIORAL HEALTH
260010475OtherRAILROAD MEDICARE
PA18538OtherHIGHMARK BLUE SHIELD
004325OtherVALUE OPTIONS
0046269000OtherPERSONAL CHOICE
0046269000OtherKEYSTONE
245004000OtherMAGELLAN
245004000OtherMAGELLAN
18538Medicare ID - Type Unspecified