Provider Demographics
NPI:1326190869
Name:BALLAL, RAGHU V (MD)
Entity Type:Individual
Prefix:DR
First Name:RAGHU
Middle Name:V
Last Name:BALLAL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:55 VILCOM CENTER DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-1689
Mailing Address - Country:US
Mailing Address - Phone:919-929-7990
Mailing Address - Fax:919-929-7991
Practice Address - Street 1:55 VILCOM CENTER DR
Practice Address - Street 2:SUITE 110
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-1689
Practice Address - Country:US
Practice Address - Phone:919-929-7990
Practice Address - Fax:919-929-7991
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2008-11-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJMA044257207R00000X
NC2007-01250207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2779776AMedicare PIN
C56606Medicare UPIN