Healthcare Provider Details

I. General information

NPI: 1992543656
Provider Name (Legal Business Name): BALAMURUGAN ULAGANATHAN MBBS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2024
Last Update Date: 07/05/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER BOULEVARD
WINSTON SALEM NC
27157-0001
US

IV. Provider business mailing address

2125 ROBIN LARK DR APT 6204
WINSTON SALEM NC
27106-9925
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-2011
  • Fax:
Mailing address:
  • Phone: 848-260-9778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2026-01579
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: