Provider Demographics
NPI:1598711376
Name:BALTER, DAVID G (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:G
Last Name:BALTER
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 1:2030 VIBORG RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SOLVANG
Mailing Address - State:CA
Mailing Address - Zip Code:93463-2220
Mailing Address - Country:US
Mailing Address - Phone:805-688-4236
Mailing Address - Fax:
Practice Address - Street 1:2030 VIBORG RD
Practice Address - Street 2:SUITE 202
Practice Address - City:SOLVANG
Practice Address - State:CA
Practice Address - Zip Code:93463-2220
Practice Address - Country:US
Practice Address - Phone:805-688-4236
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG342698207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G34269BMedicare ID - Type Unspecified
A45856Medicare UPIN