Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD-016673-E | PA |
N | 111NI0900X | Internist | MD-016673-E | PA |
Y | 207RH0000X | Hematologist | MD-016673-E | PA |
NPI | 1356375372 |
---|---|
Provider Name | Dr. Samir K. Ballas |
First Address | Philadelphia, PA 19106-4404 |
Second Address | Philadelphia, PA 19107-4414 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 02/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2187809 | (05) | NJ |