Provider Demographics
NPI:1144269937
Name:BALAKRISHNAN, DHEEPA (MD)
Entity type:Individual
Prefix:
First Name:DHEEPA
Middle Name:
Last Name:BALAKRISHNAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WYOMING ST
Mailing Address - Street 2:3110 BERRY PAVILION
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-2722
Mailing Address - Country:US
Mailing Address - Phone:937-208-6800
Mailing Address - Fax:937-208-2139
Practice Address - Street 1:1 WYOMING ST
Practice Address - Street 2:3110 BERRY PAVILION
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2722
Practice Address - Country:US
Practice Address - Phone:937-208-6800
Practice Address - Fax:937-208-2139
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.086629207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2584038Medicaid
BA4167582Medicare ID - Type Unspecified
OH2584038Medicaid