Healthcare Provider Details

I. General information

NPI: 1629028899
Provider Name (Legal Business Name): BARBARA BALBONI DALY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 01/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 OLD ROAD TO 9 ACRE COR SUITE 490
CONCORD MA
01742-4141
US

IV. Provider business mailing address

747 MAIN ST STE 111
CONCORD MA
01742-3326
US

V. Phone/Fax

Practice location:
  • Phone: 978-371-1400
  • Fax: 978-371-0246
Mailing address:
  • Phone: 978-371-1400
  • Fax: 978-371-0246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number349
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: