Provider Demographics
NPI:1720333982
Name:BALABAN, DONALD JAY (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:JAY
Last Name:BALABAN
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 1:114 ANTON RD
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-1226
Mailing Address - Country:US
Mailing Address - Phone:610-642-2408
Mailing Address - Fax:610-642-2409
Practice Address - Street 1:114 ANTON RD
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-1226
Practice Address - Country:US
Practice Address - Phone:610-642-2408
Practice Address - Fax:610-642-2409
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD016280E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine