Provider Demographics
NPI:1326039447
Name:BALLAS, STEVEN LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:LEE
Last Name:BALLAS
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 1:627 EASTLAND AVE SE
Mailing Address - Street 2:STE 301
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-4501
Mailing Address - Country:US
Mailing Address - Phone:330-392-3099
Mailing Address - Fax:330-395-1721
Practice Address - Street 1:627 EASTLAND AVE SE
Practice Address - Street 2:STE 301
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-4501
Practice Address - Country:US
Practice Address - Phone:330-392-3099
Practice Address - Fax:330-395-1721
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35047548207RC0000X, 207R00000X
PAMD043738L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0508516Medicaid
PA01483289Medicaid
OHH162972OtherMEDICARE PTAN
PA01483289Medicaid
PA01483289Medicaid