Active NPI
Roland G Kallen, MD
- Internal Medicine Physician
- Bala Cynwyd, PA
National Provider Identifier
1740410778
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 15003
- Practice address
- 101 Colwyn LN
Bala Cynwyd, PA 19004-2310 - Phone
- (610) 664-4028
- NPI assigned
- Jul 24, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 15003 | PA | Primary |
Addresses
Primary practice location
101 Colwyn LN
Bala Cynwyd, PA 19004-2310
Mailing address
101 Colwyn LN
Bala Cynwyd, PA 19004-2310
Phone (610) 664-4028
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10009605 | Other | PA | CAREMARK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15003 | PA | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1248393600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1272844800000",
"number": "1740410778",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 COLWYN LN",
"city": "BALA CYNWYD",
"state": "PA",
"postal_code": "190042310",
"telephone_number": "610-664-4028"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 COLWYN LN",
"city": "BALA CYNWYD",
"state": "PA",
"postal_code": "190042310",
"telephone_number": "610-664-4028"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KALLEN",
"first_name": "ROLAND",
"middle_name": "G",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-07-24",
"last_updated": "2010-05-03",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "PA",
"license": "15003",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAREMARK",
"identifier": "10009605",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bala Cynwyd, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.