Provider Demographics
NPI:1689633273
Name:BALCOM, JAMES H IV (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:H
Last Name:BALCOM
Suffix:IV
Gender:M
Credentials:MD
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Mailing Address - Street 1:104 ENDICOTT ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-3623
Mailing Address - Country:US
Mailing Address - Phone:978-882-6868
Mailing Address - Fax:978-882-6828
Practice Address - Street 1:104 ENDICOTT ST
Practice Address - Street 2:SUITE 200
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-3623
Practice Address - Country:US
Practice Address - Phone:978-882-6868
Practice Address - Fax:978-882-6828
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2012-05-18
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Provider Licenses
StateLicense IDTaxonomies
MA202600208600000X, 2086S0102X, 2086S0120X, 2086S0127X, 2086S0129X, 2086X0206X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MABAJ25866OtherBLUE CROSS BLUE SHIELD
MA2003180Medicaid
MA760811OtherTUFTS
MA042530297OtherCOMMERICAL
MABAJ25866OtherBLUE CROSS BLUE SHIELD
MAH84089Medicare UPIN