Provider Demographics
NPI:1417046202
Name:BALAGTAS, ABELARDO DUNGCA SR (MD)
Entity Type:Individual
Prefix:DR
First Name:ABELARDO
Middle Name:DUNGCA
Last Name:BALAGTAS
Suffix:SR
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 1:650 FRANKLIN ST STE 103
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12305-2168
Mailing Address - Country:US
Mailing Address - Phone:518-393-1367
Mailing Address - Fax:518-393-1367
Practice Address - Street 1:650 FRANKLIN ST STE 103
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12305-2168
Practice Address - Country:US
Practice Address - Phone:518-393-1367
Practice Address - Fax:518-393-1367
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY109805-1208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY78790Medicare UPIN
NY31311BMedicare ID - Type Unspecified