Provider Demographics
NPI:1073723367
Name:EVA M. BALASH, MD
Entity Type:Organization
Organization Name:EVA M. BALASH, MD
Other - Org Name:BOSTON FAMILY DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EVA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BALASH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-522-2779
Mailing Address - Street 1:1153 CENTRE ST
Mailing Address - Street 2:SUITE 5990
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3446
Mailing Address - Country:US
Mailing Address - Phone:617-522-2779
Mailing Address - Fax:617-522-5698
Practice Address - Street 1:1153 CENTRE ST
Practice Address - Street 2:SUITE 5990
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-3446
Practice Address - Country:US
Practice Address - Phone:617-522-2779
Practice Address - Fax:617-522-5698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA35713207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB15499OtherBLUE SHIELD
MA9768173Medicaid
MAM15499Medicare UPIN
MA9768173Medicaid