Provider Demographics
NPI:1023181757
Name:BALCITA, ANGEL B JR (MD)
Entity type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:B
Last Name:BALCITA
Suffix:JR
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 1:525 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:PA
Mailing Address - Zip Code:15666-1833
Mailing Address - Country:US
Mailing Address - Phone:724-547-4536
Mailing Address - Fax:724-547-3799
Practice Address - Street 1:525 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:PA
Practice Address - Zip Code:15666-1833
Practice Address - Country:US
Practice Address - Phone:724-547-4536
Practice Address - Fax:724-547-3799
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 030027E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA009203070003Medicaid
B96851Medicare UPIN
PA009203070003Medicaid