1902124977 NPI number — KRISTINE E BALLA RPH

Table of content: KRISTINE E BALLA RPH (NPI 1902124977)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902124977 NPI number — KRISTINE E BALLA RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BALLA
Provider First Name:
KRISTINE
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
F

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:
1902124977
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1130 PERRY HWY
Provider Second Line Business Mailing Address:
STE 35
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15237-2142
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-369-4267
Provider Business Mailing Address Fax Number:
412-369-8041

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1130 PERRY HWY
Provider Second Line Business Practice Location Address:
STE 35
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15237-2142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-369-4267
Provider Business Practice Location Address Fax Number:
412-369-8041
Provider Enumeration Date:
05/14/2010

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: 183500000X , with the licence number:  RP040086L , 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: RP040086L . This is a "PA STATE LICENSE NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com