Provider Demographics
NPI:1235393620
Name:ANGEL BALCITA, MD, PC
Entity Type:Organization
Organization Name:ANGEL BALCITA, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:BALCITA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:724-547-0505
Mailing Address - Street 1:PO BOX 1054
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:PA
Mailing Address - Zip Code:15666
Mailing Address - Country:US
Mailing Address - Phone:724-547-0505
Mailing Address - Fax:724-547-3942
Practice Address - Street 1:1027 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:PA
Practice Address - Zip Code:15666
Practice Address - Country:US
Practice Address - Phone:724-547-0505
Practice Address - Fax:724-547-3942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030027E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA055185OtherMEDICARE
PA00920307003Medicaid
PA00920307003Medicaid