MEDICARE: DR. THOMAS C. BALSHI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207NS0135X	Procedural Dermatology Physician	ME 88514	FL

General Provider Information

NPI Number	:	1063400646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS C. BALSHI M.D.

Provider Business Mailing Address
First Line	:	4665 W ATLANTIC AVE
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-3800
Country	:	US
Telephone Number	:	561-272-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	4665 W ATLANTIC AVE
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-3800
Country	:	US
Telephone Number	:	561-272-6000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/08/2005
Last Update Date	:	11/12/2014

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