Provider Demographics
NPI:1922034339
Name:BALU, MARAGADHAM (MD)
Entity Type:Individual
Prefix:
First Name:MARAGADHAM
Middle Name:
Last Name:BALU
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 1:1333 MERIDIAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-5212
Mailing Address - Country:US
Mailing Address - Phone:408-445-3400
Mailing Address - Fax:408-445-0107
Practice Address - Street 1:1333 MERIDIAN AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-5212
Practice Address - Country:US
Practice Address - Phone:408-445-3400
Practice Address - Fax:408-445-0107
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49852207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine