Provider Demographics
NPI:1851860936
Name:BALBACH, PAUL M BARKOVIC (NP-C)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:M BARKOVIC
Last Name:BALBACH
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 MARKET RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:DALEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24083-3258
Mailing Address - Country:US
Mailing Address - Phone:540-966-0400
Mailing Address - Fax:540-992-6669
Practice Address - Street 1:150 MARKET RIDGE LN
Practice Address - Street 2:
Practice Address - City:DALEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24083-3258
Practice Address - Country:US
Practice Address - Phone:540-816-7112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-18
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024176936363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024176936OtherLICENSED NURSE PRACTITIONER