Provider Demographics
NPI:1861667412
Name:JAMAL KALALA, MD, PLLC
Entity Type:Organization
Organization Name:JAMAL KALALA, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMAL
Authorized Official - Middle Name:M
Authorized Official - Last Name:KALALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-632-1234
Mailing Address - Street 1:225 NC HIGHWAY 16 S
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28681-3048
Mailing Address - Country:US
Mailing Address - Phone:828-632-1234
Mailing Address - Fax:828-632-8794
Practice Address - Street 1:225 NC HIGHWAY 16 S
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28681-3048
Practice Address - Country:US
Practice Address - Phone:828-632-1234
Practice Address - Fax:828-632-8794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35149207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC12601OtherBCBS
NC8912601Medicaid
2185408MOtherMEDICARE PTAN
F54176Medicare UPIN