Provider Demographics
NPI:1831194224
Name:BALAKHANI, MEHDI (MD, DDS, PA)
Entity type:Individual
Prefix:DR
First Name:MEHDI
Middle Name:
Last Name:BALAKHANI
Suffix:
Gender:M
Credentials:MD, DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4745 OGLETOWN STANTON RD
Mailing Address - Street 2:MAP #1, SUITE 226
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2067
Mailing Address - Country:US
Mailing Address - Phone:302-368-8900
Mailing Address - Fax:302-368-7866
Practice Address - Street 1:4745 OGLETOWN STANTON RD
Practice Address - Street 2:MAP #1, SUITE 226
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2067
Practice Address - Country:US
Practice Address - Phone:302-368-8900
Practice Address - Fax:302-368-7866
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0002053174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE5626138004OtherCIGNA
DE1259OtherMID-ATLANTIC
DE000414550OtherAMERIHEALTH PPO
DE414550OtherPENNA. BLUE SHIELD
DE0098679000OtherAMERIHEALTH HMO
DE510264647OtherBLUE SHIELD OF NEW JERSEY
DE52980OtherAETNA
DE0000156101Medicaid
DE1300019OtherUNITED HEALTH CARE
DE26018OtherCOVENTRY
DE510264647OtherHORIZON BLUE SHIELD NJ
DE510264647OtherBLUE SHIELD OF NEW JERSEY
DE510264647OtherHORIZON BLUE SHIELD NJ
DE414550Medicare ID - Type Unspecified