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General NPI Number Information
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NPI Number | 1649373978
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Entity Type | Individual
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Provider Name | VIJAY K KALOLA M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/05/2006
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Last Update Date | 11/09/2022
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Provider Practice Location Address
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Address Line | 300 S WARWICK RD
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City | SOMERDALE
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State | NJ
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Zip | 08083-2139
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Country | US
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Telephone | 856-784-6666
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Fax |
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Provider Business Mailing Address
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Address Line | 401 ROUTE 73 N STE 320
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City | MARLTON
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State | NJ
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Zip | 08053-3426
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Country | US
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Telephone | 856-784-6666
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 25MA06876100
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License Number State | NJ
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