Provider Demographics
NPI:1700809571
Name:BALAJI, NICHOLAS R (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:R
Last Name:BALAJI
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:PO BOX 37174
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3174
Mailing Address - Country:US
Mailing Address - Phone:703-204-9301
Mailing Address - Fax:703-204-0764
Practice Address - Street 1:3301 WOODBURN RD
Practice Address - Street 2:SUITE #301
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-1229
Practice Address - Country:US
Practice Address - Phone:703-204-9301
Practice Address - Fax:703-204-0764
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD036018207RC0000X
VA0101254584207RI0011X
DCMD036672390200000X
MDD0071982207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program