=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164818910
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MS. ANJALI BAL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/08/2015
-----------------------------------------------------
Last Update Date | 09/19/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2360 MARYLAND RD
-----------------------------------------------------
City | WILLOW GROVE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19090-1709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-657-6776
-----------------------------------------------------
Fax | 267-657-5961
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2360 MARYLAND RD
-----------------------------------------------------
City | WILLOW GROVE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19090-1709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-295-1000
-----------------------------------------------------
Fax | 434-972-4266
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number | 0101264643
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | MD473589
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------