Provider Demographics
NPI:1609112424
Name:BALIAN, PETER JOHN (DPM)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:JOHN
Last Name:BALIAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 DILLA ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-1103
Mailing Address - Country:US
Mailing Address - Phone:508-478-8214
Mailing Address - Fax:
Practice Address - Street 1:5 DILLA ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-1103
Practice Address - Country:US
Practice Address - Phone:508-478-8214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-26
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1758213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist