Healthcare Provider Details

I. General information

NPI: 1912980178
Provider Name (Legal Business Name): OFELIA C BALTA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 COPE CREEK RD STE A-B
SYLVA NC
28779-9508
US

IV. Provider business mailing address

98 COPE CREEK RD STE A-B
SYLVA NC
28779-9508
US

V. Phone/Fax

Practice location:
  • Phone: 828-586-7798
  • Fax: 866-282-0679
Mailing address:
  • Phone: 828-586-7798
  • Fax: 866-282-0679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2003-00220
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2003-00220
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier89133YP
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: