Healthcare Provider Details

I. General information

NPI: 1093967283
Provider Name (Legal Business Name): TAHA BALI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 07/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WASHINGTON ST
BOSTON MA
02111-1552
US

IV. Provider business mailing address

1010 MASSACHUSETTS AVE APT 52
CAMBRIDGE MA
02138-5371
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-5000
  • Fax: 617-636-1465
Mailing address:
  • Phone: 267-455-2520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2008013208
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number261171
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: