MEDICARE: VICTOR A BALTA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	ME 83027	FL
2	207R00000X	Internal Medicine Physician	ME83027	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	62795	OTHER	FL	BLUE CROSS

General Provider Information

NPI Number	:	1851350029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTOR A BALTA M.D.

Provider Business Mailing Address
First Line	:	4000 N HIGHWAY A1A PH 2
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34949-8530
Country	:	US
Telephone Number	:	772-359-9529
Fax Number	:

Provider Business Practice Location Address
First Line	:	4000 N HIGHWAY A1A PH 2
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34949-8530
Country	:	US
Telephone Number	:	772-359-9529
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	03/08/2012

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Directions to “ VICTOR A BALTA M.D.” Practice Location

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