Provider Demographics
NPI:1053381624
Name:KALLICH, MARSHA (MD)
Entity type:Individual
Prefix:DR
First Name:MARSHA
Middle Name:
Last Name:KALLICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:579A CRANBURY RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5426
Mailing Address - Country:US
Mailing Address - Phone:732-613-0711
Mailing Address - Fax:732-613-5783
Practice Address - Street 1:579A CRANBURY RD
Practice Address - Street 2:SUITE 102
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5426
Practice Address - Country:US
Practice Address - Phone:732-613-0711
Practice Address - Fax:732-613-5783
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA40059207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0848107Medicaid
NJ221957468OtherTAX ID
NJ221957468OtherTAX ID
NJC60478Medicare UPIN