MEDICARE: MICHAEL SANDOR BALLO 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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	D0056226	MD

General Provider Information

NPI Number	:	1780648550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL SANDOR BALLO M.D.

Provider Business Mailing Address
First Line	:	1140 BATTERY AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21230-4112
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 GEIPE RD STE 230
Second Line	:
City	:	CATONSVILLE
State	:	MD
Zip	:	21228-4176
Country	:	US
Telephone Number	:	410-247-7500
Fax Number	:	410-247-4227

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

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	03/17/2018

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