Healthcare Provider Details

I. General information

NPI: 1316074610
Provider Name (Legal Business Name): ELENA C BALAKIRSKY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 06/28/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 WALKER AVE STE 202
BALTIMORE MD
21208-4078
US

IV. Provider business mailing address

19 WALKER AVE STE 202
BALTIMORE MD
21208-4078
US

V. Phone/Fax

Practice location:
  • Phone: 410-580-1220
  • Fax: 410-520-1226
Mailing address:
  • Phone: 410-580-1220
  • Fax: 410-520-1226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0067640
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: