MEDICARE: BALA NEUROLOGY, LLC

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	2084N0400X	Neurology Physician

General Provider Information

NPI Number	:	1700562105
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALA NEUROLOGY, LLC

Provider Business Mailing Address
First Line	:	217 SPRINGHOUSE LN
Second Line	:
City	:	MERION STATION
State	:	PA
Zip	:	19066-1114
Country	:	US
Telephone Number	:	610-635-8520
Fax Number	:

Provider Business Practice Location Address
First Line	:	217 SPRINGHOUSE LN
Second Line	:
City	:	MERION STATION
State	:	PA
Zip	:	19066-1114
Country	:	US
Telephone Number	:	610-635-8520
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID TABBY
Credential	:	DO
Telephone Number	:	610-635-8520

Provider Enumeration Date	:	06/22/2023
Last Update Date	:	06/22/2023

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