Provider Demographics
NPI:1982137709
Name:DIAZ-BALZAC, CARLOS ANTONIO (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:ANTONIO
Last Name:DIAZ-BALZAC
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVENUE PO BOX 693
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-2107
Mailing Address - Country:US
Mailing Address - Phone:585-275-2901
Mailing Address - Fax:585-273-1288
Practice Address - Street 1:601 ELMWOOD AVE BOX MED
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-275-2874
Practice Address - Fax:585-273-1288
Is Sole Proprietor?:No
Enumeration Date:2017-04-07
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY298643207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program