Provider Demographics
NPI:1730123738
Name:WILEY, KALVIN JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:KALVIN
Middle Name:JOHN
Last Name:WILEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3501 SINCLAIR LN
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21213-2029
Mailing Address - Country:US
Mailing Address - Phone:410-732-8800
Mailing Address - Fax:410-534-2392
Practice Address - Street 1:3700 FLEET ST
Practice Address - Street 2:STE 200
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-4200
Practice Address - Country:US
Practice Address - Phone:410-558-4900
Practice Address - Fax:410-522-2070
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDDOO57740207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD200117998OtherCIGNA
MDJ2030000OtherFEDERAL CFBCBS
MD6813038 00Medicaid
MDKFD6OtherCFBCBS
MD6813038 00Medicaid
MDKFD6OtherCFBCBS