Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | R165241 | MD |
N | 363LG0600X | Nurse Practitioner - Gerontology | R165241 | MD |
NPI | 1053786756 |
---|---|
Provider Name | Joseph Patrick Eltanal Balao |
First Address | Baltimore, MD 21287-0010 |
Second Address | Baltimore, MD 21287-0010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2015 |
Last Update Date | 07/12/2015 |