STACI M KALLISH (NPI# 1811152796) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811152796 |
| Entity Type | Individual |
| Full Name | STACI M KALLISH |
| Credential | DO |
| Practice Address |
3400 Civic Center Blvd. 1st Floor Philadelphia PA 19104 |
| Practice Telephone | 2156622454 |
| Mailing Telephone | 2156622454 |
| Enumeration Date | 2008-07-21 |
| Last Update Date | 2019-09-13 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207SG0201X |
Medical Genetics Specialization: Clinical Genetics (M.D.) |
OS014273 | PA | Allopathic & Osteopathic Physicians |
| N | 207SG0202X |
Medical Genetics Specialization: Clinical Biochemical Genetics |
OS014273 | PA | Allopathic & Osteopathic Physicians |
| Street Address |
3400 CIVIC CENTER BLVD. 1ST FLOOR |
| City | PHILADELPHIA |
| State | PA |
| Zip Code | 19104 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548249287 | William R Rate | Radiology | 3400 Civic Center Blvd., Concourse Level, Philadelphia, PA 19104-4306 | 2006-01-11 |
| 1780045617 | Kyra Sahar O'brien | Psychiatry & Neurology | 3400 Civic Center Blvd., 2nd Floor South Pavilion, Philadelphia, PA 19104-4238 | 2016-03-20 |
| 1750644241 | Kimberly A Molinari | Nurse Practitioner | 3400 Civic Center Blvd., Pcam Rowan Breast Center, Philadelphia, PA 19104 | 2012-06-19 |
| 1962798900 | Naji M Alamuddin | Internal Medicine | 3400 Civic Center Blvd., Perelman Ctr. for Advanced Med., 4th Flr., West, Philadelphia, PA 19104 | 2011-06-28 |
| 1831409226 | Jacqueline L Zipay | Nurse Practitioner | 3400 Civic Center Blvd., 4th Floor - Perelman West, Philadelphia, PA 19104-5127 | 2010-10-19 |
| 1922237981 | Neeraj H. Panchal | Oral & Maxillofacial Surgery | 3400 Civic Center Blvd., 4th Floor, South Pavilion, Philadelphia, PA 19104 | 2009-07-10 |
| 1295963148 | Kristen N Kobaly | Internal Medicine | 3400 Civic Center Blvd., West Pavilion 4th Fl, Suite 4-900 W, Philadelphia, PA 19104 | 2009-06-30 |
| 1265660567 | Brian Curran Capell | Dermatology | 3400 Civic Center Blvd., 1-330s Perelman Center, Philadelphia, PA 19104 | 2009-06-24 |
| 1689817181 | Lisa Kimberly Pappas-taffer | Dermatology | 3400 Civic Center Blvd., 1-330s Perelman Center, Philadelphia, PA 19104 | 2009-04-13 |
| 1780846360 | Robert Gil Micheletti | Dermatology | 3400 Civic Center Blvd., 1-330s Perelman Center, Philadelphia, PA 19104 | 2008-06-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639770829 | Michelle Morris | Student in an Organized Health Care Education/Training Program | Dept. of Family Medicine & Community Health, 3737 Market, Philadelphia, PA 19104 | 2020-11-04 |
| 1346853041 | Spectrum Health Services, Inc. | Clinic/Center | 1415 South University Ave, Philadelphia, PA 19104 | 2020-08-24 |
| 1770104259 | Fatimah Sorefan-mangou | Student in an Organized Health Care Education/Training Program | 4 Maloney 3400 Spruce Street, Philadelphia, PA 19104 | 2020-05-06 |
| 1114548690 | Rebecca Blaguski | Registered Nurse | The Hospital of The University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104 | 2020-05-06 |
| 1952944175 | Rebecca Miriam Barmherzig | Psychiatry & Neurology | 3501 Civic Centre Blvd, 10th Flr Ctrb, Neurology, Philadelphia, PA 19104 | 2019-10-21 |
| 1891257101 | James Paul Byrne | Surgery | Penn Presbyterian Medical Center, Division of Trauma, S, 51 N. 39th Street, Suite 120, 1st Floor Medical Office, Philadelphia, PA 19104 | 2019-04-04 |
| 1093276453 | Lauren Shreve | Student in an Organized Health Care Education/Training Program | Department of Surgery, Surgery Education - Penn Health, 3400 Spruce Street, 4 Maloney, Philadelphia, PA 19104 | 2019-03-28 |
| 1285194282 | Lauren M Christie | Student in an Organized Health Care Education/Training Program | Penn Presbyterian Medical Center, 51 N. 39th Street, Philadelphia, PA 19104 | 2019-03-25 |
| 1114487683 | Sabrina Layne | Student in an Organized Health Care Education/Training Program | 3400 Spruce Street, 100 Centrex, Philadelphia, PA 19104 | 2019-03-21 |
| 1811457310 | Kia Lor | Student in an Organized Health Care Education/Training Program | Hospital of University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104 | 2019-03-21 |
| Find all providers in zip 19104 | ||||
| Taxonomy Code | 207SG0201X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Medical Genetics |
| Specialization | Clinical Genetics (M.D.) |
| A clinical geneticist demonstrates competence in providing comprehensive diagnostic, management and counseling services for genetic disorders. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Medical Genetics, 2007. http://www.abmg.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Medical Genetics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922317759 | Mindy Li | Medical Genetics | 3615 Civic Center Blvd, Children's Hosp of Philadelphia, Room 1002 Abramson Res. Bldg, Dept of Medical Genetics, Philadelphia, PA 19104-4399 | 2010-09-28 |
| 1083857858 | Reena Natwarlal Jethva | Medical Genetics | 3601 A Street, 3rd Floor Acp, Suite 3314, St. Christopher's Hospital for Children, Philadelphia, PA 19134-1095 | 2009-04-09 |
| 1649324955 | Ghodrat P Sholevar | Medical Genetics | 618 W Lehigh Ave, Philadelphia, PA 19133 | 2007-01-23 |
| 1699878678 | Adele Schneider | Medical Genetics | 840 Walnut St Ste 1210, Philadelphia, PA 19107-5109 | 2006-09-06 |
| 1871139691 | Stc Opco LLC | Medical Genetics | 160 E Erie Ave, Philadelphia, PA 19134-1011 | 2019-11-27 |
| 1396389805 | Stc Pediatrics LLC | Medical Genetics | 160 E Erie Ave, Philadelphia, PA 19134-1011 | 2019-10-29 |
| 1336650456 | Kim Choong Wen Ng | Medical Genetics | 3401 Civic Center Blvd, Philadelphia, PA 19104-4319 | 2017-10-16 |
| 1396199543 | Rose Guo | Medical Genetics | 3401 Civic Center Blvd, Division of Human Genetics, Philadelphia, PA 19104 | 2016-04-13 |
| 1750776225 | Theodore George Drivas | Medical Genetics | 3400 Civic Center Blvd, Ste 3005, Philadelphia, PA 19104-5127 | 2015-04-01 |
| 1518355627 | University of Penn-medical Group | Medical Genetics | 3400 Spruce St, 8 Ravdin, Philadelphia, PA 19104-4238 | 2014-12-26 |
| Find all providers in PHILADELPHIA | ||||
| City | PHILADELPHIA |
| Zip Code | 19104 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.