Healthcare Provider Details

I. General information

NPI: 1376102822
Provider Name (Legal Business Name): ARCHANA BALAKRISHNAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2019
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 N 15TH ST FL 6
PHILADELPHIA PA
19102-1101
US

IV. Provider business mailing address

245 N 15TH ST FL 6
PHILADELPHIA PA
19102-1101
US

V. Phone/Fax

Practice location:
  • Phone: 215-762-7916
  • Fax:
Mailing address:
  • Phone: 215-762-7916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMT218245
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: