Provider Demographics
NPI:1134145170
Name:BALZARETT, JOSEPH RAYMOND (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:RAYMOND
Last Name:BALZARETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:8206 LEESBURG PIKE
Mailing Address - Street 2:#207
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2614
Mailing Address - Country:US
Mailing Address - Phone:703-893-8585
Mailing Address - Fax:703-893-3879
Practice Address - Street 1:8206 LEESBURG PIKE
Practice Address - Street 2:#207
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-2614
Practice Address - Country:US
Practice Address - Phone:703-893-8585
Practice Address - Fax:703-893-3879
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010231702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry