Basic Information
| Provider Information | |||||||||
| NPI: | 1629028899 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BALBONI DALY | ||||||||
| FirstName: | BARBARA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 747 MAIN ST | ||||||||
| Address2: | STE 111 | ||||||||
| City: | CONCORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017423326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9783711400 | ||||||||
| FaxNumber: | 9783710246 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 OLD ROAD TO 9 ACRE COR | ||||||||
| Address2: | SUITE 490 | ||||||||
| City: | CONCORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017424141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9783711400 | ||||||||
| FaxNumber: | 9783710246 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 01/04/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 349 | MA | Y | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | AD0108 | 01 | MA | BLUE CROSS BLUE SHIELD | OTHER |