MEDICARE: DR. JOAN BALABAN 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	208000000X	Pediatrics Physician	MD038814E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MD038814E	OTHER	PA	LICENSE NUMBER
2	MD038814E	OTHER	PA	MEDICAL LICENSE NUMBER

General Provider Information

NPI Number	:	1760624894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOAN BALABAN MD

Provider Business Mailing Address
First Line	:	6910 WISSAHICKON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19119-3728
Country	:	US
Telephone Number	:	215-844-2044
Fax Number	:	215-844-2046

Provider Business Practice Location Address
First Line	:	6910 WISSAHICKON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19119-3728
Country	:	US
Telephone Number	:	215-844-2044
Fax Number	:	215-844-2046

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

Provider Enumeration Date	:	04/06/2009
Last Update Date	:	04/06/2009

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