Provider Demographics
NPI:1699723031
Name:KALETA, ANDREA D (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:D
Last Name:KALETA
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:PO BOX 20
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21769-0020
Mailing Address - Country:US
Mailing Address - Phone:301-371-9000
Mailing Address - Fax:301-371-8905
Practice Address - Street 1:300 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:MD
Practice Address - Zip Code:21769-8043
Practice Address - Country:US
Practice Address - Phone:301-371-9000
Practice Address - Fax:301-371-8905
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD69718207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH9310007OtherBCBS NCA#
MD96136601OtherBCBS MARYLAND #
MD419498500Medicaid
COA503-8Medicare ID - Type Unspecified
MD96136601OtherBCBS MARYLAND #