Provider Demographics
NPI:1285624577
Name:BALOG, NORMAN M (DO)
Entity type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:M
Last Name:BALOG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15504 WILLISTON RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20905-4243
Mailing Address - Country:US
Mailing Address - Phone:301-879-0179
Mailing Address - Fax:
Practice Address - Street 1:15504 WILLISTON RD
Practice Address - Street 2:DOC AT YOUR DOOR, LLC
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20905-4243
Practice Address - Country:US
Practice Address - Phone:301-879-0179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0048219207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine