Provider Demographics
NPI:1295275832
Name:PERIYASAMY, BALAKUMAR
Entity type:Individual
Prefix:MR
First Name:BALAKUMAR
Middle Name:
Last Name:PERIYASAMY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43997 RIVERPOINT DR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-8202
Mailing Address - Country:US
Mailing Address - Phone:202-487-8221
Mailing Address - Fax:
Practice Address - Street 1:205 GILES ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:TX
Practice Address - Zip Code:75571-4013
Practice Address - Country:US
Practice Address - Phone:703-880-6448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No171W00000XOther Service ProvidersContractor