Provider Demographics
NPI:1912980178
Name:BALTA, OFELIA C (MD)
Entity Type:Individual
Prefix:DR
First Name:OFELIA
Middle Name:C
Last Name:BALTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 COPE CREEK RD STE A-B
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-9508
Mailing Address - Country:US
Mailing Address - Phone:828-586-7798
Mailing Address - Fax:866-282-0679
Practice Address - Street 1:98 COPE CREEK RD STE A-B
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-9508
Practice Address - Country:US
Practice Address - Phone:828-586-7798
Practice Address - Fax:866-282-0679
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2003-00220208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89133YPMedicaid
NCH82661Medicare UPIN
NC2014623Medicare ID - Type Unspecified