Provider Demographics
NPI:1639159841
Name:BALCOM, WILLIAM B (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:B
Last Name:BALCOM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:123 SUMMER STREET
Mailing Address - Street 2:SUITE 320
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608
Mailing Address - Country:US
Mailing Address - Phone:508-368-3140
Mailing Address - Fax:508-368-3143
Practice Address - Street 1:123 SUMMER STREET
Practice Address - Street 2:SUITE 320
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608
Practice Address - Country:US
Practice Address - Phone:508-368-3140
Practice Address - Fax:508-368-3143
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA77380207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2115778Medicaid
MAF71041Medicare UPIN
MA2115778Medicaid