Healthcare Provider Details

I. General information

NPI: 1205330412
Provider Name (Legal Business Name): LAUREN BALKAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE
BOSTON MA
02215-5491
US

IV. Provider business mailing address

505 E 70TH ST
NEW YORK NY
10021-4872
US

V. Phone/Fax

Practice location:
  • Phone: 617-667-7000
  • Fax:
Mailing address:
  • Phone: 212-746-9663
  • Fax: 212-746-3609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number1014936
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number311334
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number1014936
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: