Provider Demographics
NPI:1174519847
Name:BALOCH, FARYAL (MD)
Entity type:Individual
Prefix:DR
First Name:FARYAL
Middle Name:
Last Name:BALOCH
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 1:1775 ACCESS RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-1987
Mailing Address - Country:US
Mailing Address - Phone:678-729-0003
Mailing Address - Fax:770-255-0125
Practice Address - Street 1:1775 ACCESS RD
Practice Address - Street 2:SUITE C
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-1987
Practice Address - Country:US
Practice Address - Phone:678-729-0003
Practice Address - Fax:770-255-0125
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050939207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAI18219Medicare UPIN
GA66BBBGWMedicare ID - Type Unspecified