Provider Demographics
NPI:1003931163
Name:BALTER, JOSHUA O (NAVY IDC)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:O
Last Name:BALTER
Suffix:
Gender:M
Credentials:NAVY IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WAHOO AVE
Mailing Address - Street 2:SUBASE NLON
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-2324
Mailing Address - Country:US
Mailing Address - Phone:860-694-4123
Mailing Address - Fax:860-694-2511
Practice Address - Street 1:1 WAHOO AVE
Practice Address - Street 2:SUBASE NLON
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-2324
Practice Address - Country:US
Practice Address - Phone:860-694-4123
Practice Address - Fax:860-694-2511
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman