Provider Demographics
NPI:1124195219
Name:ROGER BALOGH
Entity Type:Organization
Organization Name:ROGER BALOGH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BALOGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-454-0366
Mailing Address - Street 1:PO BOX 790
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43702-0790
Mailing Address - Country:US
Mailing Address - Phone:740-454-0366
Mailing Address - Fax:740-454-3790
Practice Address - Street 1:2951 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-1406
Practice Address - Country:US
Practice Address - Phone:740-454-0366
Practice Address - Fax:740-454-3790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDC7216OtherRR GRP NUMBER
OHRO9350081Medicare PIN
OHDC7216OtherRR GRP NUMBER