Individual
SUDARSHAN BALLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1 HOSPTIAL DR, DC095, COLUMBIA, MO 65212
(573) 884-2123
(573) 884-2168
Mailing address
1 MEDICAL CENTER DR, MORGANTOWN, WV 26506-1200
(304) 598-4000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2008013469
MO
207RC0000X
Cardiovascular Disease Physician
Primary
27816
WV
Other
Enumeration date
07/09/2008
Last updated
05/16/2018
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