Provider Demographics
NPI:1073570354
Name:BALBA, GAYLE PHADUNGCHAI (MD)
Entity Type:Individual
Prefix:DR
First Name:GAYLE
Middle Name:PHADUNGCHAI
Last Name:BALBA
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Gender:F
Credentials:MD
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Mailing Address - Street 1:3800 RESERVOIR RD NW
Mailing Address - Street 2:KOBER-COGAN BLD SUITE110
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-2113
Mailing Address - Country:US
Mailing Address - Phone:202-687-6845
Mailing Address - Fax:202-687-6476
Practice Address - Street 1:3800 RESERVOIR RD NW
Practice Address - Street 2:KOBER-COGAN BLD SUITE110
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-2113
Practice Address - Country:US
Practice Address - Phone:202-687-6845
Practice Address - Fax:202-687-6476
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2009-06-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
DCMD31818207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCP00706930OtherRAILROAD MEDICARE
DCP00706930OtherRAILROAD MEDICARE
H85279Medicare UPIN