Provider Demographics
NPI:1437685492
Name:BALKAM, COLLEEN B (MD)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:B
Last Name:BALKAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:MARIE
Other - Last Name:BAUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23000 MOAKLEY ST STE 102
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-2916
Mailing Address - Country:US
Mailing Address - Phone:301-475-5555
Mailing Address - Fax:301-475-5914
Practice Address - Street 1:23000 MOAKLEY ST STE 102
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-2916
Practice Address - Country:US
Practice Address - Phone:301-475-5555
Practice Address - Fax:301-475-5914
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101275178207X00000X
MDD0094327207XS0114X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery