Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | MD31818 | DC |
NPI | 1073570354 |
---|---|
Provider Name | Dr. Gayle Phadungchai Balba |
First Address | Washington, DC 20007-2113 |
Second Address | Washington, DC 20007-2113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2006 |
Last Update Date | 26/06/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H85279 | (02) | |
P00706930 | RAILROAD MEDICARE (01) | DC |