Provider Demographics
NPI:1750371902
Name:BALEWICK, DONNA L (MD)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:L
Last Name:BALEWICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:835 HOSPITAL RD
Mailing Address - Street 2:PO BOX 788
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-0788
Mailing Address - Country:US
Mailing Address - Phone:724-357-7009
Mailing Address - Fax:724-357-7414
Practice Address - Street 1:835 HOSPITAL RD
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-0788
Practice Address - Country:US
Practice Address - Phone:724-357-7121
Practice Address - Fax:724-357-7479
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD068765L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000707682OtherBLUE CROSS
PA206338OtherUPMC
PA0017664080003Medicaid
PA000707682OtherBLUE CROSS
PA0017664080003Medicaid