Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | SC006389 | PA |
NPI | 1063776466 |
---|---|
Provider Name | Dr. Megan S Balliet |
First Address | Northampton, PA 18067-1798 |
Second Address | Northampton, PA 18067-1798 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2012 |
Last Update Date | 27/06/2019 |