Provider Demographics
NPI:1649485053
Name:BARHAM, KALLEEN S (MD)
Entity type:Individual
Prefix:
First Name:KALLEEN
Middle Name:S
Last Name:BARHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HYGEIA DR
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2049
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4735 OGLETOWN STANTON ROAD
Practice Address - Street 2:MAP 2, SUITE 3201
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2094
Practice Address - Country:US
Practice Address - Phone:302-623-4323
Practice Address - Fax:302-623-4315
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT182516390200000X
DEC10005133207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program