Provider Demographics
NPI:1740410778
Name:KALLEN, ROLAND G (MD)
Entity Type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:G
Last Name:KALLEN
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 1:101 COLWYN LN
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-2310
Mailing Address - Country:US
Mailing Address - Phone:610-664-4028
Mailing Address - Fax:
Practice Address - Street 1:101 COLWYN LN
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-2310
Practice Address - Country:US
Practice Address - Phone:610-664-4028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-24
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA15003207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA10009605OtherCAREMARK