Provider Demographics
NPI:1952477317
Name:BALSAMO, LUKE HODGSON (MD)
Entity Type:Individual
Prefix:DR
First Name:LUKE
Middle Name:HODGSON
Last Name:BALSAMO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:627 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23508-2117
Mailing Address - Country:US
Mailing Address - Phone:757-961-1911
Mailing Address - Fax:757-953-5490
Practice Address - Street 1:620 JOHN PAUL JONES CIR
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23708-2111
Practice Address - Country:US
Practice Address - Phone:757-953-1814
Practice Address - Fax:757-953-5490
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101102569207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery