Provider Demographics
NPI:1669441812
Name:BALUCH, JOHN D (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:BALUCH
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E MAIN ST
Mailing Address - Street 2:STE 220
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215
Mailing Address - Country:US
Mailing Address - Phone:614-222-3369
Mailing Address - Fax:614-224-1208
Practice Address - Street 1:500 E MAIN ST
Practice Address - Street 2:STE 220
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215
Practice Address - Country:US
Practice Address - Phone:614-222-3369
Practice Address - Fax:614-224-1208
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35065452B208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3115821773A11OtherANTHEM
4330118OtherAETNA PPO
19109OtherCOLUMBUS CCOP NUMBER
4221OtherNATIONWIDE HEALTH PLANS
961814OtherAETNA HMO
16724OtherAM ASSOC OF CLINICAL UROL
311582177001OtherCIGNA
315649OtherAUA PERSONAL ID NUMBER
04112840112OtherMEDICAL ED NUMBER
190073OtherAM ASSOC OF CLINICAL UROL
OH0931657Medicaid
22746OtherNCI INVESTIGATORS NUMBER
22746OtherNCI INVESTIGATORS NUMBER
OH0931657Medicaid
04112840112OtherMEDICAL ED NUMBER