Provider Demographics
NPI:1144414061
Name:BALER, RICARDO GUILLERMO (MD)
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:GUILLERMO
Last Name:BALER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 PERIMETER PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-8442
Mailing Address - Country:US
Mailing Address - Phone:984-215-4110
Mailing Address - Fax:
Practice Address - Street 1:1515 SW CARY PKWY STE 220
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6224
Practice Address - Country:US
Practice Address - Phone:919-387-3160
Practice Address - Fax:919-387-3165
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA437608208000000X
NC2014-00024208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102332862Medicaid