Provider Demographics
NPI:1003860172
Name:BALON, STANLEY RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:RICHARD
Last Name:BALON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:175 NATE WHIPPLE HWY
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-1416
Mailing Address - Country:US
Mailing Address - Phone:401-658-1744
Mailing Address - Fax:401-658-1750
Practice Address - Street 1:175 NATE WHIPPLE HWY
Practice Address - Street 2:SUITE 204
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-1416
Practice Address - Country:US
Practice Address - Phone:401-658-1744
Practice Address - Fax:401-658-1750
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-21
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI5801207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9001130Medicaid
RI9001130Medicaid
RID66112Medicare UPIN