Provider Demographics
NPI:1750347894
Name:BALAJI, MALUR R (MD FACS)
Entity type:Individual
Prefix:DR
First Name:MALUR
Middle Name:R
Last Name:BALAJI
Suffix:
Gender:M
Credentials:MD FACS
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Mailing Address - Street 1:ONE MEDICAL CENTER BLVD
Mailing Address - Street 2:ACP, SUITE 233
Mailing Address - City:CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19013-3902
Mailing Address - Country:US
Mailing Address - Phone:610-499-0400
Mailing Address - Fax:610-499-1970
Practice Address - Street 1:ONE MEDICAL CENTER BLVD
Practice Address - Street 2:ACP, SUITE 233
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-3902
Practice Address - Country:US
Practice Address - Phone:610-499-0400
Practice Address - Fax:610-499-1970
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2014-10-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1243772086S0129X
PAMD4475162086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00446135Medicaid
NY100722FPOtherPREFFERDCARE
NYPO10124377OtherBLUECROSS AND BLUE SHEILD
NY00446135Medicaid
NYPO10124377OtherBLUECROSS AND BLUE SHEILD