1750347894 NPI number — DR. MALUR R BALAJI MD. FACS

Table of content: DR. MALUR R BALAJI MD. FACS (NPI 1750347894)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750347894 NPI number — DR. MALUR R BALAJI MD. FACS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BALAJI
Provider First Name:
MALUR
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD. FACS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750347894
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ONE MEDICAL CENTER BLVD
Provider Second Line Business Mailing Address:
ACP, SUITE 233
Provider Business Mailing Address City Name:
CHESTER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19013-3902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-499-0400
Provider Business Mailing Address Fax Number:
610-499-1970

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ONE MEDICAL CENTER BLVD
Provider Second Line Business Practice Location Address:
ACP, SUITE 233
Provider Business Practice Location Address City Name:
CHESTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19013-3902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-499-0400
Provider Business Practice Location Address Fax Number:
610-499-1970
Provider Enumeration Date:
04/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X , with the licence number:  124377 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X , with the licence number: MD447516 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00446135 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100722FP . This is a "PREFFERDCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: PO10124377 . This is a "BLUECROSS AND BLUE SHEILD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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