Healthcare Provider Details

I. General information

NPI: 1255626016
Provider Name (Legal Business Name): FADI BALLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2011
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2875 NE STUCKI AVE
HILLSBORO OR
97124-5806
US

IV. Provider business mailing address

500 NE MULTNOMAH ST FL 11
PORTLAND OR
97232-2023
US

V. Phone/Fax

Practice location:
  • Phone: 971-310-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD187825
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: