Provider Demographics
NPI:1861542565
Name:BALAGTAS-BALMASEDA, OFELIA (MD)
Entity type:Individual
Prefix:DR
First Name:OFELIA
Middle Name:
Last Name:BALAGTAS-BALMASEDA
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 1:830 E GILCHRIST DR
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-4740
Mailing Address - Country:US
Mailing Address - Phone:812-299-7422
Mailing Address - Fax:812-299-1683
Practice Address - Street 1:4812 S 7TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-4502
Practice Address - Country:US
Practice Address - Phone:812-299-7422
Practice Address - Fax:812-299-1683
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN100379842081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN22000000105419OtherBLUE CROSS BLUE SHIELD
IN200006770AMedicaid
IN10780112OtherCAQH
IN22000000105419OtherBLUE CROSS BLUE SHIELD
B403032Medicare UPIN