Provider Demographics
NPI:1811708589
Name:BALADO, ROBERTO LUIS (PA-C)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:LUIS
Last Name:BALADO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 TOWNE ST APT 610
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-5945
Mailing Address - Country:US
Mailing Address - Phone:203-666-6972
Mailing Address - Fax:
Practice Address - Street 1:305 BLACK ROCK TPKE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-5508
Practice Address - Country:US
Practice Address - Phone:203-337-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant