Provider Demographics
NPI:1437119427
Name:BALTI, MOHAMAD (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMAD
Middle Name:
Last Name:BALTI
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:PO BOX 2461
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14240-2461
Mailing Address - Country:US
Mailing Address - Phone:716-834-1191
Mailing Address - Fax:
Practice Address - Street 1:3112 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1904
Practice Address - Country:US
Practice Address - Phone:716-831-9435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY139264207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00011260201OtherUNIVERA
NY00581315Medicaid
NY2005260OtherINDEPENDENT HEALTH
NY000565033001OtherBLUE CROSS
051820982OtherRAILROAD MEDICARE
NY00020545801OtherUNIVERA
051820982OtherRAILROAD MEDICARE