Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | C1-0005467 | DE |
NPI | 1073594693 |
---|---|
Provider Name | Dr. Ganesh R Balu |
First Address | Dover, DE 19904-8208 |
Second Address | Dover, DE 19904-8208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2005 |
Last Update Date | 09/12/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000898401 | (05) | DE |
G33975 | (02) | DE |