Provider Demographics
NPI:1700268786
Name:KALLMAN, MARIA GREEN (PA)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:GREEN
Last Name:KALLMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 LAVELLE CT.
Mailing Address - Street 2:PO BOX 144
Mailing Address - City:UNALASKA
Mailing Address - State:AK
Mailing Address - Zip Code:99685
Mailing Address - Country:US
Mailing Address - Phone:907-581-1202
Mailing Address - Fax:
Practice Address - Street 1:34 LAVELLE CT.
Practice Address - Street 2:
Practice Address - City:UNALASKA
Practice Address - State:AK
Practice Address - Zip Code:99685
Practice Address - Country:US
Practice Address - Phone:907-581-1202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-25
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0004294363AM0700X
AK131031363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1684141Medicaid