Provider Demographics
NPI:1568490530
Name:BALBOA, WILLIAM T (CRNA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:T
Last Name:BALBOA
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-5210
Mailing Address - Country:US
Mailing Address - Phone:814-943-1272
Mailing Address - Fax:814-940-8510
Practice Address - Street 1:217 GLENN ST
Practice Address - Street 2:SUITE 400
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2460
Practice Address - Country:US
Practice Address - Phone:301-722-7246
Practice Address - Fax:301-777-2624
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN193928L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS34981Medicare UPIN
PA090052Medicare ID - Type Unspecified