Basic Information
| Provider Information | |||||||||
| NPI: | 1164953055 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BALA | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | OREOLUWA BALARABE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1208 PRINCETON AVE | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282091430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2057929243 | ||||||||
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| Practice Location | |||||||||
| Address1: | 501 S SHARON AMITY RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282110035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043772424 | ||||||||
| FaxNumber: | 7043772687 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2017 | ||||||||
| LastUpdateDate: | 10/09/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | R4333 | KY | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 2020-01061 | NC | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.