1669472650 NPI number — DR. KATHRYN VANCKO BALAZS D.O.

Table of content: DR. KATHRYN VANCKO BALAZS D.O. (NPI 1669472650)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669472650 NPI number — DR. KATHRYN VANCKO BALAZS D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BALAZS
Provider First Name:
KATHRYN
Provider Middle Name:
VANCKO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1669472650
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/08/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3572 DAYTON XENIA RD
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
BEAVERCREEK
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45432-2886
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-427-4600
Provider Business Mailing Address Fax Number:
937-427-4520

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3572 DAYTON XENIA RD
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
BEAVERCREEK
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45432-2886
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-427-4600
Provider Business Practice Location Address Fax Number:
937-427-4520
Provider Enumeration Date:
07/30/2005

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: 207N00000X , with the licence number:  34006753B , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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