Healthcare Provider Details

I. General information

NPI: 1659370864
Provider Name (Legal Business Name): MARVIN S. KALACHMAN PA-C, M.S., DFAAPA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 05/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 SHONEY DR SW SUITE 120
HUNTSVILLE AL
35801-5436
US

IV. Provider business mailing address

PO BOX 13148
HUNTSVILLE AL
35802-4049
US

V. Phone/Fax

Practice location:
  • Phone: 256-883-3231
  • Fax: 256-883-9577
Mailing address:
  • Phone: 256-883-3231
  • Fax: 256-883-9577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-26
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: