Provider Demographics
NPI:1578534988
Name:MAC, HARJIT BALA (MD)
Entity Type:Individual
Prefix:MRS
First Name:HARJIT
Middle Name:BALA
Last Name:MAC
Suffix:
Gender:F
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:PO BOX 1230
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28002
Mailing Address - Country:US
Mailing Address - Phone:704-988-3314
Mailing Address - Fax:704-983-3315
Practice Address - Street 1:816 N 3RD ST
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001
Practice Address - Country:US
Practice Address - Phone:704-983-3314
Practice Address - Fax:704-983-3315
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24607208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
53637OtherBCBS
NC8953637Medicaid
NC8953637Medicaid
208402Medicare ID - Type Unspecified