Provider Demographics
NPI:1689652935
Name:BALAA, MARWAN A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARWAN
Middle Name:A
Last Name:BALAA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2520 SAMARITAN DR
Mailing Address - Street 2:#201
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124
Mailing Address - Country:US
Mailing Address - Phone:408-402-9990
Mailing Address - Fax:408-402-0330
Practice Address - Street 1:2520 SAMARITAN DR
Practice Address - Street 2:#201
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124
Practice Address - Country:US
Practice Address - Phone:408-402-9990
Practice Address - Fax:408-402-0330
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC42734207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C42734Medicare ID - Type Unspecified
E61279Medicare UPIN