Provider Demographics
NPI:1639404254
Name:KAUR, BALJIT (PA)
Entity Type:Individual
Prefix:
First Name:BALJIT
Middle Name:
Last Name:KAUR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 MEDICAL CAMPUS DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-7205
Mailing Address - Country:US
Mailing Address - Phone:215-257-8391
Mailing Address - Fax:215-453-6955
Practice Address - Street 1:3401 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5103
Practice Address - Country:US
Practice Address - Phone:215-707-3133
Practice Address - Fax:215-707-3945
Is Sole Proprietor?:No
Enumeration Date:2009-10-15
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054223208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery