Provider Demographics
NPI:1437129814
Name:BALABAN, EDWARD P (DO)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:P
Last Name:BALABAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 CREEKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PENLLYN
Mailing Address - State:PA
Mailing Address - Zip Code:19422-2727
Mailing Address - Country:US
Mailing Address - Phone:724-799-1258
Mailing Address - Fax:
Practice Address - Street 1:829 CREEKVIEW DR
Practice Address - Street 2:
Practice Address - City:PENLLYN
Practice Address - State:PA
Practice Address - Zip Code:19422-2727
Practice Address - Country:US
Practice Address - Phone:724-799-1258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004287L207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAF41506Medicare UPIN
PA11311428OtherCAQH
PA0014647660009Medicaid
PA069471PZBMedicare PIN
PA069471OtherHIGHMARK BS
PAF41506Medicare UPIN
PA830007586Medicare PIN
WV3810011969Medicaid