Provider Demographics
NPI:1023596566
Name:BALANDIAT, JULIA ANNE (PA-C)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:ANNE
Last Name:BALANDIAT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 E NORTH AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4756
Mailing Address - Country:US
Mailing Address - Phone:412-359-6200
Mailing Address - Fax:412-359-6617
Practice Address - Street 1:320 E NORTH AVE STE 208
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4756
Practice Address - Country:US
Practice Address - Phone:412-359-6200
Practice Address - Fax:412-359-6617
Is Sole Proprietor?:No
Enumeration Date:2018-08-06
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA061472363A00000X
OH50.005573RX363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA14308327OtherCAQH
PAPENDINGMedicaid