Provider Demographics
NPI:1699095075
Name:S. BALACHANDRAN, MD, PA
Entity type:Organization
Organization Name:S. BALACHANDRAN, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUBRAMANIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BALACHANDRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-799-3326
Mailing Address - Street 1:PO BOX 797
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75146-0797
Mailing Address - Country:US
Mailing Address - Phone:254-694-5092
Mailing Address - Fax:254-694-7039
Practice Address - Street 1:1007 S WILLIAM ST
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:TX
Practice Address - Zip Code:75551-3245
Practice Address - Country:US
Practice Address - Phone:903-799-3326
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0656208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty