1164731303 NPI number — RALITSA V BALABANOVA-TSARNAKOVA MD

Table of content: RALITSA V BALABANOVA-TSARNAKOVA MD (NPI 1164731303)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164731303 NPI number — RALITSA V BALABANOVA-TSARNAKOVA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BALABANOVA-TSARNAKOVA
Provider First Name:
RALITSA
Provider Middle Name:
V
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TSARNAKOVA
Provider Other First Name:
RALITSA
Provider Other Middle Name:
V
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1164731303
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/27/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1850 E PARK AVE
Provider Second Line Business Mailing Address:
STE 302
Provider Business Mailing Address City Name:
STATE COLLEGE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16803-6706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-278-4680
Provider Business Mailing Address Fax Number:
814-235-1523

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1850 E PARK AVE
Provider Second Line Business Practice Location Address:
STE 302
Provider Business Practice Location Address City Name:
STATE COLLEGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16803-6706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-278-4680
Provider Business Practice Location Address Fax Number:
814-235-1523
Provider Enumeration Date:
10/06/2010

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: 207R00000X , with the licence number:  MD441329 , 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)





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