MEDICARE: JOHN A BALACKO 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	207RC0000X	Cardiovascular Disease Physician	MD036R70E	PA
2	207RI0011X	Interventional Cardiology Physician	MD036270E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942269311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN A BALACKO MD

Provider Business Mailing Address
First Line	:	1624 PACIFIC AVE STE B
Second Line	:
City	:	NATRONA HEIGHTS
State	:	PA
Zip	:	15065-2145
Country	:	US
Telephone Number	:	724-226-3345
Fax Number	:	724-226-2415

Provider Business Practice Location Address
First Line	:	1624 PACIFIC AVE STE B
Second Line	:
City	:	NATRONA HEIGHTS
State	:	PA
Zip	:	15065-2145
Country	:	US
Telephone Number	:	724-226-3345
Fax Number	:	724-226-2415

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

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	10/01/2020

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Directions to “ JOHN A BALACKO MD” Practice Location

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