Healthcare Provider Details

I. General information

NPI: 1245235167
Provider Name (Legal Business Name): TAMAS BALOGH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 08/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 S SOUTH ST STE 200
MOUNT AIRY NC
27030
US

IV. Provider business mailing address

PO BOX 249
YADKINVILLE NC
27055-0249
US

V. Phone/Fax

Practice location:
  • Phone: 336-786-6146
  • Fax:
Mailing address:
  • Phone: 336-679-4963
  • Fax: 336-679-2549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number9600446
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number9600446
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: