Basic Information
| Provider Information | |||||||||
| NPI: | 1750347894 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BALAJI | ||||||||
| FirstName: | MALUR | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD. FACS | ||||||||
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| Mailing Information | |||||||||
| Address1: | ONE MEDICAL CENTER BLVD | ||||||||
| Address2: | ACP, SUITE 233 | ||||||||
| City: | CHESTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190133902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104990400 | ||||||||
| FaxNumber: | 6104991970 | ||||||||
| Practice Location | |||||||||
| Address1: | ONE MEDICAL CENTER BLVD | ||||||||
| Address2: | ACP, SUITE 233 | ||||||||
| City: | CHESTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190133902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104990400 | ||||||||
| FaxNumber: | 6104991970 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 10/15/2014 | ||||||||
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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 | 2086S0129X | 124377 | NY | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 2086S0129X | MD447516 | PA | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | 00446135 | 05 | NY | MEDICAID | 100722FP | 01 | NY | PREFFERDCARE | OTHER | PO10124377 | 01 | NY | BLUECROSS AND BLUE SHEILD | OTHER |