Healthcare Provider Details

I. General information

NPI: 1013034909
Provider Name (Legal Business Name): ROBERT JOHN BALCHICK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 09/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 CAMPUS VIEW ROAD
NEW ALBANY OH
43054
US

IV. Provider business mailing address

7701 CHARLOTTE HULL CT
NEW ALBANY OH
43054-9680
US

V. Phone/Fax

Practice location:
  • Phone: 614-933-5814
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number048066
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: