Provider Demographics
NPI:1477516888
Name:BALZER, NAOMI S (MD)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:S
Last Name:BALZER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NAOMI
Other - Middle Name:S
Other - Last Name:HAAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3400 CIVIC CENTER BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5127
Mailing Address - Country:US
Mailing Address - Phone:215-615-5858
Mailing Address - Fax:215-349-8144
Practice Address - Street 1:3400 CIVIC CENTER BOULEVARD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-5127
Practice Address - Country:US
Practice Address - Phone:215-615-5858
Practice Address - Fax:215-349-8144
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036623174400000X
PAMD036623E207RH0003X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No174400000XOther Service ProvidersSpecialist
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA575628Medicare UPIN
PA575628Medicare PIN
PAF95591Medicare UPIN