Provider Demographics
NPI:1649663675
Name:DARRYL J BALLIN, MD, INC
Entity type:Organization
Organization Name:DARRYL J BALLIN, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BALLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-708-4848
Mailing Address - Street 1:5525 ETIWANDA AVE
Mailing Address - Street 2:224
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3647
Mailing Address - Country:US
Mailing Address - Phone:818-708-4848
Mailing Address - Fax:818-436-4680
Practice Address - Street 1:5525 ETIWANDA AVE
Practice Address - Street 2:224
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3647
Practice Address - Country:US
Practice Address - Phone:818-708-4848
Practice Address - Fax:818-436-4680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-16
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty