Provider Demographics
NPI:1952405045
Name:BALASH, EVA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:MARIE
Last Name:BALASH
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 1:1153 CENTRE ST
Mailing Address - Street 2:STE 5G
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130
Mailing Address - Country:US
Mailing Address - Phone:617-983-7324
Mailing Address - Fax:617-983-7334
Practice Address - Street 1:1153 CENTRE ST
Practice Address - Street 2:STE 5G
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130
Practice Address - Country:US
Practice Address - Phone:617-522-2779
Practice Address - Fax:617-522-5698
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA35713207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
035713OtherTUFTS
MA3045048Medicaid
4321OtherPILGRIM
MA3045048Medicaid
4321OtherPILGRIM