Provider Demographics
NPI:1518963503
Name:BALA, PETER Z (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:Z
Last Name:BALA
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 1:30 MEDICAL PARK
Mailing Address - Street 2:STE 219
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-6391
Mailing Address - Country:US
Mailing Address - Phone:304-243-7160
Mailing Address - Fax:304-243-6372
Practice Address - Street 1:30 MEDICAL PARK
Practice Address - Street 2:STE 219
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-6391
Practice Address - Country:US
Practice Address - Phone:304-243-7160
Practice Address - Fax:304-243-6372
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19281207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
19281OtherHEALTH PLAN OF UPPER OH V
WV0093691000Medicaid
OH2163037Medicaid
G66211Medicare UPIN
OH4128211Medicare PIN
OH4128212Medicare PIN
OH2163037Medicaid