Healthcare Provider Details

I. General information

NPI: 1437452034
Provider Name (Legal Business Name): NERON BALASSANIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2010
Last Update Date: 10/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10650 NE 9TH PL UNIT 2322
BELLEVUE WA
98004-5080
US

IV. Provider business mailing address

10650 NE 9TH PL UNIT 2322
BELLEVUE WA
98004-5080
US

V. Phone/Fax

Practice location:
  • Phone: 425-260-0179
  • Fax:
Mailing address:
  • Phone: 425-260-0179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number18592
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: