Provider Demographics
NPI:1326596974
Name:MEDBALANCE, LLC
Entity type:Organization
Organization Name:MEDBALANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELISTATHIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-507-5110
Mailing Address - Street 1:4701 SANGAMORE RD
Mailing Address - Street 2:SUITE N270
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20816-2508
Mailing Address - Country:US
Mailing Address - Phone:240-507-5110
Mailing Address - Fax:844-682-8102
Practice Address - Street 1:4701 SANGAMORE RD
Practice Address - Street 2:SUITE N270
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20816-2508
Practice Address - Country:US
Practice Address - Phone:240-507-5110
Practice Address - Fax:844-682-8102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD59980207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty