Provider Demographics
NPI:1508085887
Name:KALLA, ABHISHEK (MD)
Entity Type:Individual
Prefix:
First Name:ABHISHEK
Middle Name:
Last Name:KALLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 CATON AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-5201
Mailing Address - Country:US
Mailing Address - Phone:667-234-2910
Mailing Address - Fax:667-234-3517
Practice Address - Street 1:900 CATON AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-5201
Practice Address - Country:US
Practice Address - Phone:667-234-2910
Practice Address - Fax:667-234-3517
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD79335207RH0003X
VA0101254311207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology