Provider Demographics
NPI:1942213186
Name:BALCONIS, ANDREA J (MD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:J
Last Name:BALCONIS
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 1:706 NORTH 7TH STREET
Mailing Address - Street 2:
Mailing Address - City:FT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:706 NORTH 7TH STREET
Practice Address - Street 2:
Practice Address - City:FT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950
Practice Address - Country:US
Practice Address - Phone:772-469-9900
Practice Address - Fax:772-468-2364
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0063483207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265689200Medicaid
F59008Medicare UPIN
FL265689200Medicaid