Provider Demographics
NPI:1417983123
Name:BALA, RUPA (MD)
Entity Type:Individual
Prefix:
First Name:RUPA
Middle Name:
Last Name:BALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 W HIGHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-4716
Mailing Address - Country:US
Mailing Address - Phone:352-726-8353
Mailing Address - Fax:352-341-6885
Practice Address - Street 1:5575 E SR 44
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:FL
Practice Address - Zip Code:34785-8282
Practice Address - Country:US
Practice Address - Phone:352-571-4418
Practice Address - Fax:352-661-3905
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME159707207RC0001X
ORMD169147207RC0000X
PAMD417638207RC0000X, 207RC0001X
NY308921207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology