=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376558155
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LARRY BALING MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3150 HIGHLAND RD
-----------------------------------------------------
City | HERMITAGE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16148-4516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-342-1070
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3150 HIGHLAND RD
-----------------------------------------------------
City | HERMITAGE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16148-4516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | TINA CLARICH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 724-342-1070
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------