Provider Demographics
NPI:1669426094
Name:BALOTESCU, RAZVAN (MD)
Entity type:Individual
Prefix:DR
First Name:RAZVAN
Middle Name:
Last Name:BALOTESCU
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 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:
Practice Address - Street 1:228 PONTE VEDRA PARK DR STE 500
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-6611
Practice Address - Country:US
Practice Address - Phone:904-273-1180
Practice Address - Fax:904-273-6116
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001581207R00000X
FLME99489207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00025874503OtherUNIVERA
NY000526685002OtherBLUE CROSS BLUE SHIELD
NY02342363Medicaid
NY0411353OtherINDEPENDENT HEALTH
NY0411353OtherINDEPENDENT HEALTH
H54065Medicare UPIN