Basic Information
| Provider Information | |||||||||
| NPI: | 1053798876 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BALI | ||||||||
| FirstName: | GURVINDER | ||||||||
| MiddleName: | SINGH | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1327 | ||||||||
| Address2: | |||||||||
| City: | LACONIA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 032471327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6039342060 | ||||||||
| FaxNumber: | 6035277038 | ||||||||
| Practice Location | |||||||||
| Address1: | LACONIA CLINIC | ||||||||
| Address2: | 724 NORTH MAIN STREET | ||||||||
| City: | LACONIA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 032462742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3139660463 | ||||||||
| FaxNumber: | 6035272770 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2015 | ||||||||
| LastUpdateDate: | 12/12/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 19045 | NH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.