Provider Demographics
NPI:1538148804
Name:BALON, WALTER A (MD)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:A
Last Name:BALON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:425 ESSJAY RD STE 170
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-8235
Mailing Address - Country:US
Mailing Address - Phone:716-630-1219
Mailing Address - Fax:716-817-1726
Practice Address - Street 1:85 HIGH ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1149
Practice Address - Country:US
Practice Address - Phone:716-630-1000
Practice Address - Fax:716-630-1348
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2019-07-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY144353-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000508553005OtherHEALTH NOW
NY110129481OtherRR MEDICARE
NY161000580OtherNORTH AMERICAN PREFERRED
NY00758232Medicaid
NY0407897OtherIHA
NY161000580OtherEMPIRE
NY144353-0BOtherWORKER'S COMPENSATION
NY00010141901OtherUNIVERA
NY000508553005OtherHEALTH NOW
NY110129481OtherRR MEDICARE