Provider Demographics
NPI:1023163847
Name:BALLIAN, NIKIFOROS (MBBS)
Entity type:Individual
Prefix:DR
First Name:NIKIFOROS
Middle Name:
Last Name:BALLIAN
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W 39TH ST
Mailing Address - Street 2:APT. 411
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-3107
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 N WOLFE ST
Practice Address - Street 2:BLALOCK 655
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0005
Practice Address - Country:US
Practice Address - Phone:410-955-6796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MD208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery