Provider Demographics
NPI:1518155969
Name:PAUL J BALZER, MD
Entity Type:Organization
Organization Name:PAUL J BALZER, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BALZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-681-8100
Mailing Address - Street 1:49 PINELAND DR
Mailing Address - Street 2:SUITE 302A
Mailing Address - City:NEW GLOUCESTER
Mailing Address - State:ME
Mailing Address - Zip Code:04260-5119
Mailing Address - Country:US
Mailing Address - Phone:207-681-8100
Mailing Address - Fax:207-681-8102
Practice Address - Street 1:49 PINELAND DR
Practice Address - Street 2:SUITE 302A
Practice Address - City:NEW GLOUCESTER
Practice Address - State:ME
Practice Address - Zip Code:04260-5119
Practice Address - Country:US
Practice Address - Phone:207-681-8100
Practice Address - Fax:207-681-8102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty