Healthcare Provider Details

I. General information

NPI: 1144276239
Provider Name (Legal Business Name): BALBIR SINGH CHAUHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 08/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 PULASKI HWY SUITE 204
JOPPA MD
21085-3610
US

IV. Provider business mailing address

413 PULASKI HWY SUITE 204
JOPPA MD
21085-3610
US

V. Phone/Fax

Practice location:
  • Phone: 410-679-2122
  • Fax: 410-679-3065
Mailing address:
  • Phone: 410-679-2122
  • Fax: 410-679-3065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0025032
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: