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General NPI Number Information
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NPI Number | 1295036580
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Entity Type | Organization
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Legal Business Name | MARWAN A BALAA MD INC
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Dates
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Enumeration Date | 11/03/2010
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Last Update Date | 11/03/2010
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Provider Practice Location Address
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Address Line | 2520 SAMARITAN DR SUITE 201
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City | SAN JOSE
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State | CA
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Zip | 95124-4106
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Country | US
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Telephone | 408-402-9990
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Fax | 408-402-0330
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Provider Business Mailing Address
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Address Line | 2520 SAMARITAN DR SUITE 201
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City | SAN JOSE
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State | CA
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Zip | 95124-4106
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Country | US
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Telephone | 408-402-9990
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Fax | 408-402-0330
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARWAN A BALAA
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Credential | M.D.
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Telephone | 408-402-9990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | C42734
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License Number State | CA
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