Provider Demographics
NPI:1790793107
Name:BALCH, PATTY JOYCE (MD)
Entity Type:Individual
Prefix:
First Name:PATTY
Middle Name:JOYCE
Last Name:BALCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 602658
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2658
Mailing Address - Country:US
Mailing Address - Phone:336-794-2434
Mailing Address - Fax:
Practice Address - Street 1:2828 MAPLEWOOD AVE # B
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4138
Practice Address - Country:US
Practice Address - Phone:336-794-2434
Practice Address - Fax:336-794-2436
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30775207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC82684Medicare UPIN
NCNC5364AMedicare PIN