Individual
DR. KENNETH G. KALASSIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
333 COTTMAN AVE, PHILADELPHIA, PA 19111-2434
(215) 728-6900
(215) 214-4044
Mailing address
2450 W HUNTING PARK AVE, PHILADELPHIA, PA 19129-1302
(727) 532-0002
(727) 266-4943
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
051669
GA
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
51977
SC
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
ME108047
FL
207RP1001X
Pulmonary Disease Physician
051669
GA
207RP1001X
Pulmonary Disease Physician
Primary
51977
SC
207RP1001X
Pulmonary Disease Physician
MD073250L
PA
207RP1001X
Pulmonary Disease Physician
ME108047
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003664000
—
FL
01
—
14E0T
BLUE CROSS BLUE SHIELD
FL
05
—
519772
—
SC
01
—
FC156W
MEDICARE TIN
FL
Enumeration date
08/11/2006
Last updated
01/04/2022
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