Provider Demographics
NPI:1245235167
Name:BALOGH, TAMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:TAMAS
Middle Name:
Last Name:BALOGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:YADKINVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27055-0249
Mailing Address - Country:US
Mailing Address - Phone:336-679-4963
Mailing Address - Fax:336-679-2549
Practice Address - Street 1:708 S SOUTH ST STE 200
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030
Practice Address - Country:US
Practice Address - Phone:336-786-6146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600446207RC0000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1434017OtherUNITED HEALTHCARE
NC2702499OtherAETNA HMO
NC5255420OtherAETNA PPO
NC66909OtherMEDCOST
NC8912888Medicaid
NC137861OtherSOUTHCARE PPO
NC16442OtherPARTNERS MEDICARE
NC110141504OtherMEDICARE RAILROAD
NC111397OtherCIGNA
NC12888OtherBCBS OF NC
NC377877OtherMAMSI
NC377877OtherMAMSI
NC111397OtherCIGNA
NC66909OtherMEDCOST