Provider Demographics
NPI:1023283462
Name:BALONOV, KONSTANTIN (MD)
Entity type:Individual
Prefix:
First Name:KONSTANTIN
Middle Name:
Last Name:BALONOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3 TURNBRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:HOPKINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01748-1651
Mailing Address - Country:US
Mailing Address - Phone:617-636-0544
Mailing Address - Fax:617-636-8384
Practice Address - Street 1:800 WASHINGTON ST
Practice Address - Street 2:# 298, ANESTHESIOLOGY
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1552
Practice Address - Country:US
Practice Address - Phone:617-636-0544
Practice Address - Fax:617-636-8384
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA225664207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology