Provider Demographics
NPI:1891975892
Name:ADNAN KALELI MD, PC
Entity Type:Organization
Organization Name:ADNAN KALELI MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADNAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KALELI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-472-7003
Mailing Address - Street 1:1147 HANCOCK ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4343
Mailing Address - Country:US
Mailing Address - Phone:617-472-7003
Mailing Address - Fax:617-471-9910
Practice Address - Street 1:1147 HANCOCK ST
Practice Address - Street 2:SUITE 205
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4343
Practice Address - Country:US
Practice Address - Phone:617-472-7003
Practice Address - Fax:617-471-9910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA53276208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6180892Medicaid
MAM14913OtherBLUE CROSS BLUE SHIELD
MAB97746Medicare UPIN
MAM14913OtherBLUE CROSS BLUE SHIELD