Healthcare Provider Details

I. General information

NPI: 1932104742
Provider Name (Legal Business Name): JOHN BALKO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 01/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 N KEEL RIDGE RD
HERMITAGE PA
16148-3440
US

IV. Provider business mailing address

102 N KEEL RIDGE RD
HERMITAGE PA
16148-3440
US

V. Phone/Fax

Practice location:
  • Phone: 866-758-4862
  • Fax: 330-758-4886
Mailing address:
  • Phone: 866-758-4862
  • Fax: 330-758-4886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberSL001837L
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: