Individual
KALLUKALAM JOSEPH MATHEW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6504 KENILWORTH AVE, SUITE 200, RIVERDALE, MD 20737-1386
(301) 927-8011
(301) 699-1584
Mailing address
6504 KENILWORTH AVE, SUITE 200, RIVERDALE, MD 20737-1386
(301) 927-8011
(301) 699-1584
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
D0014799
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
060042761
—
MD
Enumeration date
05/23/2006
Last updated
07/31/2014
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