Provider Demographics
NPI:1437116225
Name:BALUTA, ALPHONSE J JR (MD)
Entity Type:Individual
Prefix:
First Name:ALPHONSE
Middle Name:J
Last Name:BALUTA
Suffix:JR
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 1:44 BIRCH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-2752
Mailing Address - Country:US
Mailing Address - Phone:603-421-9616
Mailing Address - Fax:603-421-2451
Practice Address - Street 1:44 BIRCH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-2752
Practice Address - Country:US
Practice Address - Phone:603-421-9616
Practice Address - Fax:603-421-2451
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6541207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3084117Medicaid
NHP00395089Medicare PIN
NH3084117Medicaid
NHNH034401Medicare PIN
NHNH034401Medicare PIN