Provider Demographics
NPI:1124024724
Name:BALF-SORAN, GABRIELA (MD)
Entity type:Individual
Prefix:
First Name:GABRIELA
Middle Name:
Last Name:BALF-SORAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GABRIELA
Other - Middle Name:
Other - Last Name:BALF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:3501 CHISHOLM TRL
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0999
Mailing Address - Country:US
Mailing Address - Phone:203-707-0881
Mailing Address - Fax:701-425-0596
Practice Address - Street 1:3501 CHISHOLM TRL
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0999
Practice Address - Country:US
Practice Address - Phone:203-707-0881
Practice Address - Fax:701-425-0596
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND130012084P0800X
CT039083207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2V0554OtherHEALTHNET
CTP2398034OtherOXFORD
CT001390830Medicaid
CT2592109OtherAETNA
CT010039083CT01OtherANTHEM BLUE SHIELD
CT110220039OtherRAILROAD MEDICARE
CT767518OtherCONNECTICARE
CT010039083CT01OtherANTHEM BLUE SHIELD
CTH32613Medicare UPIN