Provider Demographics
NPI:1043282379
Name:BALASSANIAN, RONALD (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:BALASSANIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 DIVISADERO ST
Mailing Address - Street 2:UCSF/MT. ZION MEDICAL CENTER, ROOM 200 FNA CLINIC
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3010
Mailing Address - Country:US
Mailing Address - Phone:415-514-6642
Mailing Address - Fax:415-353-7676
Practice Address - Street 1:1600 DIVISADERO ST
Practice Address - Street 2:UCSF/MT. ZION MEDICAL CENTER, ROOM 200 FNA CLINIC
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3010
Practice Address - Country:US
Practice Address - Phone:415-514-6642
Practice Address - Fax:415-353-7676
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA231336207ZP0102X, 207ZC0500X
PAMD425251207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101164898Medicaid
PA101164898Medicaid
PA083984EK4Medicare ID - Type Unspecified