MEDICARE: DR. STEVEN LEO BALT MD

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	2084P0800X	Psychiatry Physician	A87849	CA

General Provider Information

NPI Number	:	1235308297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN LEO BALT MD

Provider Business Mailing Address
First Line	:	705 4TH ST
Second Line	:	SUITE 4
City	:	SAN RAFAEL
State	:	CA
Zip	:	94901-3233
Country	:	US
Telephone Number	:	415-484-2258
Fax Number	:	415-684-7774

Provider Business Practice Location Address
First Line	:	705 4TH ST
Second Line	:	SUITE 4
City	:	SAN RAFAEL
State	:	CA
Zip	:	94901-3233
Country	:	US
Telephone Number	:	415-484-2258
Fax Number	:	415-684-7774

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

Provider Enumeration Date	:	02/25/2008
Last Update Date	:	09/24/2012

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