| Bala Family Practice | |
|
2021b Emmorton Rd Suite 210 Bel Air MD 21015-8980 | |
| (410) 569-1001 | |
| (410) 569-1569 |
| Full Name | Bala Family Practice |
|---|---|
| Speciality | Clinic/Center |
| Location | 2021b Emmorton Rd, Bel Air, Maryland |
| Authorized Official Name and Position | Sriram H Balasubramanian (OWNER) |
| Authorized Official Contact | 4105691001 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bala Family Practice 2021b Emmorton Rd Suite 210 Bel Air MD 21015-8980 Ph: (410) 569-1001 | Bala Family Practice 2021b Emmorton Rd Suite 210 Bel Air MD 21015-8980 Ph: (410) 569-1001 |
| NPI Number | 1386898443 |
|---|---|
| Provider Enumeration Date | 11/14/2008 |
| Last Update Date | 06/01/2010 |
| Medicare PECOS PAC ID | 2860556628 |
|---|---|
| Medicare Enrollment ID | O20090123000197 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386898443 | NPI | - | NPPES |
| 793302900 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | D52279 (Maryland) | Primary |
| Provider Name | Sriram H Balasubramanian |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1952366056 PECOS PAC ID: 3971667734 Enrollment ID: I20090123000169 |
| Provider Name | Noel H Stallmann |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962858928 PECOS PAC ID: 9739474305 Enrollment ID: I20160822000681 |
| Provider Name | Nicole H Herpick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770132391 PECOS PAC ID: 7214360684 Enrollment ID: I20191126001544 |
| Provider Name | Samantha N Marsee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972240588 PECOS PAC ID: 3375926579 Enrollment ID: I20220822001604 |
| Provider Name | Tara Yvette Mcdonald |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447039425 PECOS PAC ID: 3870942295 Enrollment ID: I20231211003109 |
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