Healthcare Provider Details

I. General information

NPI: 1326163528
Provider Name (Legal Business Name): ROBERT W. KALISH, M.D., LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 OLD FORTY FOOT RD BOX 178
SKIPPACK PA
19474-0178
US

IV. Provider business mailing address

2450 OLD FORTY FOOT RD P.O. BOX 178
SKIPPACK PA
19474-0178
US

V. Phone/Fax

Practice location:
  • Phone: 610-222-0446
  • Fax: 610-222-4101
Mailing address:
  • Phone: 610-222-0446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD029379L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier176269821
Identifier TypeOTHER
Identifier State
Identifier IssuerUNITED BEHAVIORAL HEALTH
# 2
Identifier260010475
Identifier TypeOTHER
Identifier State
Identifier IssuerRAILROAD MEDICARE
# 3
Identifier18538
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK BLUE SHIELD
# 4
Identifier004325
Identifier TypeOTHER
Identifier State
Identifier IssuerVALUE OPTIONS
# 5
Identifier0046269000
Identifier TypeOTHER
Identifier State
Identifier IssuerPERSONAL CHOICE
# 6
Identifier0046269000
Identifier TypeOTHER
Identifier State
Identifier IssuerKEYSTONE
# 7
Identifier245004000
Identifier TypeOTHER
Identifier State
Identifier IssuerMAGELLAN

VIII. Authorized Official

Name: DR. ROBERT W KALISH
Title or Position: OWNER OPERATOR
Credential: M.D.
Phone: 610-222-0446