Provider Demographics
NPI:1295036580
Name:MARWAN A BALAA MD INC
Entity Type:Organization
Organization Name:MARWAN A BALAA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARWAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BALAA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-402-9990
Mailing Address - Street 1:2520 SAMARITAN DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4106
Mailing Address - Country:US
Mailing Address - Phone:408-402-9990
Mailing Address - Fax:408-402-0330
Practice Address - Street 1:2520 SAMARITAN DR
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4106
Practice Address - Country:US
Practice Address - Phone:408-402-9990
Practice Address - Fax:408-402-0330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC42734207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE61279Medicare UPIN