Provider Demographics
NPI:1386614345
Name:BALBASTRO, ELPIDIA H (MD)
Entity type:Individual
Prefix:
First Name:ELPIDIA
Middle Name:H
Last Name:BALBASTRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:337-942-7898
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:1200 HOSPITAL DR STE 2
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6552
Practice Address - Country:US
Practice Address - Phone:337-942-7898
Practice Address - Fax:337-942-7808
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7417207RH0003X
KY40557207RH0003X
IL036085269207RH0003X, 207RX0202X
TNMD0000041542207RH0003X
LA309969207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
5080652OtherAETNA PROVIDER PIN#
KY0910609OtherUMWA
271459OtherHEALTH LINK
KY7100021930Medicaid
IL036085269OtherIL DEPT OF PUBLIC AID
KYG09596OtherBLUEGRASS FAMILY HEALTH
020248399OtherDEPT OF LABOR
1234850OtherCHA
KY123712OtherHEALTH ALLIANCE-PHP
TN3827817Medicaid
TN000000236043OtherUNISON HEALTH PLAN MEDICARE ADVANTAGE
KY00000504506OtherANTHEM BCBS KY
TN41960OtherTLC
020248399OtherDEPT OF LABOR
KY0910609OtherUMWA
5080652OtherAETNA PROVIDER PIN#
TN000000236043OtherUNISON HEALTH PLAN MEDICARE ADVANTAGE