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NPI Code Detail

MEDICARE: MICHAEL JOHN BALASCHI

MEDICARE:   MICHAEL JOHN BALASCHI
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
1101Y00000XCounselor

General Provider Information

NPI Number : 1285994541
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL JOHN BALASCHI
Provider Business Mailing Address
First Line : 111 EDGARTOWN VINEYARD HAVEN RD
Second Line :
City : VINEYARD HAVEN
State : MA
Zip : 02568-4036
Country : US
Telephone Number : 508-693-7900
Fax Number : 508-693-7192
Provider Business Practice Location Address
First Line : 111 EDGARTOWN VINEYARD HAVEN RD
Second Line :
City : VINEYARD HAVEN
State : MA
Zip : 02568-4036
Country : US
Telephone Number : 508-693-7900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/21/2012
Last Update Date : 05/22/2012

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