Provider Demographics
NPI:1659370864
Name:KALACHMAN, MARVIN S (PA-C, MS, DFAAPA)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:S
Last Name:KALACHMAN
Suffix:
Gender:M
Credentials:PA-C, MS, DFAAPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13148
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-4049
Mailing Address - Country:US
Mailing Address - Phone:256-883-3231
Mailing Address - Fax:256-883-9577
Practice Address - Street 1:810 SHONEY DR SW
Practice Address - Street 2:SUITE 120
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5436
Practice Address - Country:US
Practice Address - Phone:256-883-3231
Practice Address - Fax:256-883-9577
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA-26363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-92232OtherAMERICAN BEHAVIORAL HEALTH FED BC (FOR 165 WHITESPORT DR, HUNTSVILLE, AL)
51599673OtherAMERICAN BEHAVIORAL HEALTH FEDERAL BLUE CROSS
AL515-92232OtherFEDERAL BLUE CROSS (FOR 165 WHITESPORT DR, HUNTSVILLE,AL)
AL51505201OtherBLUE CROSS BLUE SHIELD
51599673OtherAMERICAN BEHAVIORAL HEALTH FEDERAL BLUE CROSS
AL515-92232OtherFEDERAL BLUE CROSS (FOR 165 WHITESPORT DR, HUNTSVILLE,AL)
ALR35681Medicare UPIN