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General NPI Number Information
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NPI Number | 1386898443
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Entity Type | Organization
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Legal Business Name | BALA FAMILY PRACTICE
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Dates
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Enumeration Date | 11/14/2008
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Last Update Date | 06/01/2010
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Provider Practice Location Address
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Address Line | 2021B EMMORTON RD SUITE 210
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City | BEL AIR
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State | MD
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Zip | 21015-8980
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Country | US
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Telephone | 410-569-1001
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Fax | 410-569-1569
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Provider Business Mailing Address
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Address Line | 2021B EMMORTON RD SUITE 210
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City | BEL AIR
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State | MD
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Zip | 21015-8980
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Country | US
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Telephone | 410-569-1001
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Fax | 141-056-9156
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Authorized Official
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Title or Position | OWNER
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Name | DR. SRIRAM H BALASUBRAMANIAN
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Credential | M.D
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Telephone | 410-569-1001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | D52279
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License Number State | MD
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