Provider Demographics
NPI:1063146942
Name:BALANI, PRACHI LAXMAN (MD (ECFMG CERTIFIED))
Entity type:Individual
Prefix:DR
First Name:PRACHI
Middle Name:LAXMAN
Last Name:BALANI
Suffix:
Gender:F
Credentials:MD (ECFMG CERTIFIED)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SAINT VINCENT HOSPITAL, 123 SUMMER STREET
Mailing Address - Street 2:GRADUATE MEDICAL EDUCATION
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-2176
Mailing Address - Country:US
Mailing Address - Phone:508-363-5000
Mailing Address - Fax:
Practice Address - Street 1:SAINT VINCENT HOSPITAL, 123 SUMMER STREET
Practice Address - Street 2:GRADUATE MEDICAL EDUCATION
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-2176
Practice Address - Country:US
Practice Address - Phone:508-363-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-15
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA293814390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program