Provider Demographics
NPI:1114098647
Name:BALLA, SOMASEKHARA R (MD)
Entity Type:Individual
Prefix:
First Name:SOMASEKHARA
Middle Name:R
Last Name:BALLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:101 EAGLE CT
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-3262
Mailing Address - Country:US
Mailing Address - Phone:919-724-5533
Mailing Address - Fax:
Practice Address - Street 1:2100 STANTONSBURG RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2818
Practice Address - Country:US
Practice Address - Phone:252-537-9268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200000716207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
5861179OtherVIRGINIA MEDICAID
020384900OtherDIVISION OF COAL MINERS
06006150OtherRAILROAD MEDICARE PALMETT
NC127WXOtherBCBSNC
2556735OtherUNITED HEALTHCARE
NC89127WXMedicaid
18619OtherCAPITOL BC PENN
A3306OtherMEDCOST
VA028182OtherVABCBS
A3306OtherMEDCOST
06006150OtherRAILROAD MEDICARE PALMETT