Provider Demographics
NPI:1760584411
Name:MURTHY, BALA K (MD)
Entity Type:Individual
Prefix:DR
First Name:BALA
Middle Name:K
Last Name:MURTHY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:BALAKRISHNAN
Other - Middle Name:
Other - Last Name:BALAGURUMURTHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1304 BUCKLEY RD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-4311
Mailing Address - Country:US
Mailing Address - Phone:315-478-3311
Mailing Address - Fax:315-476-5211
Practice Address - Street 1:1304 BUCKLEY RD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-4311
Practice Address - Country:US
Practice Address - Phone:315-478-3311
Practice Address - Fax:315-476-5211
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235497207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02658139Medicaid
NYG51710Medicare UPIN
NYRA7575Medicare ID - Type Unspecified