Healthcare Provider Details

I. General information

NPI: 1962055780
Provider Name (Legal Business Name): ROBERT KALADISH MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2019
Last Update Date: 07/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 PONEMAH RD STE 2
AMHERST NH
03031-2834
US

IV. Provider business mailing address

PO BOX 130
WILTON NH
03086-0130
US

V. Phone/Fax

Practice location:
  • Phone: 603-673-5558
  • Fax:
Mailing address:
  • Phone: 603-673-5558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT KALADISH
Title or Position: PHYSICIAN, OWNER AND MANAGER
Credential: MD
Phone: 603-673-5558