Individual
DR. LEORA BETH BALSAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
55 LAKE AVENUE NORTH, DEPARTMENT OF SURGERY, WORCESTER, MA 01655-0001
(508) 334-2577
(508) 334-7284
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
248717-1
NY
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
273202
MA
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
A69615
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A869820
—
CA
Enumeration date
09/18/2007
Last updated
11/02/2020
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