Provider Demographics
NPI:1003860172
Name:BALON, STANLEY RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:RICHARD
Last Name:BALON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20 CUMBERLAND HILL RD UNIT 202
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-4854
Mailing Address - Country:US
Mailing Address - Phone:401-488-4003
Mailing Address - Fax:401-488-4474
Practice Address - Street 1:20 CUMBERLAND HILL RD UNIT 202
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-4854
Practice Address - Country:US
Practice Address - Phone:401-488-4003
Practice Address - Fax:014-884-4744
Is Sole Proprietor?:No
Enumeration Date:2006-05-21
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI05801207R00000X
RI5801207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9001130Medicaid
RI9001130Medicaid
RID66112Medicare UPIN