Provider Demographics
NPI:1821058967
Name:MEDICAL ASSOCIATES OF THE TONAWANDAS P.C.
Entity Type:Organization
Organization Name:MEDICAL ASSOCIATES OF THE TONAWANDAS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:BALTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-570-1064
Mailing Address - Street 1:PO BOX 2461
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14240-2461
Mailing Address - Country:US
Mailing Address - Phone:716-834-1191
Mailing Address - Fax:
Practice Address - Street 1:3112 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1904
Practice Address - Country:US
Practice Address - Phone:716-831-9345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
030589Medicare ID - Type Unspecified