Healthcare Provider Details

I. General information

NPI: 1679708424
Provider Name (Legal Business Name): MONA A KALEEM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2009
Last Update Date: 11/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 W REDWOOD ST STE 470
BALTIMORE MD
21201-7009
US

IV. Provider business mailing address

301 SAINT PAUL PL TOWER BUILDING, MEDICINE
BALTIMORE MD
21202-2102
US

V. Phone/Fax

Practice location:
  • Phone: 667-214-1111
  • Fax: 410-328-1178
Mailing address:
  • Phone: 410-332-9694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number1679708424
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: