Provider Demographics
NPI:1073594693
Name:BALU, GANESH R (MD)
Entity Type:Individual
Prefix:DR
First Name:GANESH
Middle Name:R
Last Name:BALU
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 1:240 BEISER BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-8208
Mailing Address - Country:US
Mailing Address - Phone:302-734-7246
Mailing Address - Fax:302-678-8890
Practice Address - Street 1:240 BEISER BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-8208
Practice Address - Country:US
Practice Address - Phone:302-734-7246
Practice Address - Fax:302-678-8890
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0005467204R00000X, 2081P2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000898401Medicaid
DEG00160Medicare ID - Type Unspecified
DEG33975Medicare UPIN