Provider Demographics
NPI:1861462939
Name:BALSAMA, LOUIS H (DO)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:H
Last Name:BALSAMA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:856-247-7210
Mailing Address - Fax:856-247-7511
Practice Address - Street 1:338 HURFFVILLE CROSSKEYS RD
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-9202
Practice Address - Country:US
Practice Address - Phone:856-589-0600
Practice Address - Fax:856-589-7979
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB07912000208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0074934Medicaid
NJ0074934Medicaid
NJ093808Medicare PIN