Provider Demographics
NPI:1265410062
Name:BALEPUR, SHYAM S (MD)
Entity type:Individual
Prefix:
First Name:SHYAM
Middle Name:S
Last Name:BALEPUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2106 HARRISBURG PIKE
Mailing Address - Street 2:SUITE 116
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2644
Mailing Address - Country:US
Mailing Address - Phone:717-544-3600
Mailing Address - Fax:717-544-3604
Practice Address - Street 1:2106 HARRISBURG PIKE
Practice Address - Street 2:SUITE 116
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2644
Practice Address - Country:US
Practice Address - Phone:717-544-3600
Practice Address - Fax:717-544-3604
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD070796L207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02158602OtherCAPITAL BLUE CROSS
PA2340762OtherAETNA HMO
PAH18220OtherHEALTH ASSURANCE
PA7402122OtherAETNA NON-HMO
PA0018060850001Medicaid
PA1518638OtherGATEWAY HEALTH PLAN
PA73619 4336OtherGEISINGER HEALTH PLAN
PA851733OtherHIGHMARK BLUE SHIELD
PA1518638OtherGATEWAY HEALTH PLAN
PA7402122OtherAETNA NON-HMO