Healthcare Provider Details

I. General information

NPI: 1629077151
Provider Name (Legal Business Name): MOHAMMED KALAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13116 BRUSHWOOD WAY
POTOMAC MD
20854-1025
US

IV. Provider business mailing address

PO BOX 70635
BETHESDA MD
20813-0635
US

V. Phone/Fax

Practice location:
  • Phone: 571-275-9279
  • Fax:
Mailing address:
  • Phone: 202-775-9375
  • Fax: 202-776-9088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number30842
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: