Provider Demographics
NPI:1760260293
Name:KALU, ERNEST JOHN (NP)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:JOHN
Last Name:KALU
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:ERNEST
Other - Middle Name:JOHN
Other - Last Name:KALU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:8 TOMBER CT
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-4240
Mailing Address - Country:US
Mailing Address - Phone:144-385-8070
Mailing Address - Fax:
Practice Address - Street 1:10 N GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1524
Practice Address - Country:US
Practice Address - Phone:410-605-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR183127363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health