Healthcare Provider Details

I. General information

NPI: 1558660761
Provider Name (Legal Business Name): SAMUEL KALLUS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2011
Last Update Date: 05/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RESERVOIR RD NW DEPT OF MEDICINE
WASHINGTON DC
20007-2113
US

IV. Provider business mailing address

2150 PENNSYLVANIA AVENUE, NW DEPARTMENT OF MEDICINE
WASHINGTON DC
20037
US

V. Phone/Fax

Practice location:
  • Phone: 202-444-8168
  • Fax: 877-303-1460
Mailing address:
  • Phone: 202-741-3333
  • Fax: 202-741-2169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD040964
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: