Provider Demographics
NPI:1952527269
Name:BALLAS, MARC SALIM (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:SALIM
Last Name:BALLAS
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:DR
Other - First Name:MOURAD
Other - Middle Name:SALIM
Other - Last Name:BALLAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD MPH
Mailing Address - Street 1:5 RESEARCH PKWY
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-1951
Mailing Address - Country:US
Mailing Address - Phone:203-677-5252
Mailing Address - Fax:203-677-6691
Practice Address - Street 1:160 E 34TH ST
Practice Address - Street 2:RM 820
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4744
Practice Address - Country:US
Practice Address - Phone:212-731-6645
Practice Address - Fax:212-731-5545
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD62998207R00000X
NY229026207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine