Healthcare Provider Details

I. General information

NPI: 1750344891
Provider Name (Legal Business Name): AMY ELIZABETH BALKA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 09/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13478 CARROLLTON BLVD UNIT D & E
CARROLLTON VA
23314-3208
US

IV. Provider business mailing address

856 J CLYDE MORRIS BLVD STE A
NEWPORT NEWS VA
23601-1318
US

V. Phone/Fax

Practice location:
  • Phone: 757-238-7043
  • Fax: 757-238-7052
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101237568
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: