Individual
DR. VANITHA BALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
111 VISION PARK BLVD, STE 150, SHENANDOAH, TX 77384-3002
(936) 321-0033
(936) 321-0032
Mailing address
PO BOX 130894, THE WOODLANDS, TX 77393
(936) 321-0033
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
055919
GA
207RG0100X
Gastroenterology Physician
Primary
Q0405
TX
390200000X
Student in an Organized Health Care Education/Training Program
0116022282
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
345954701
—
TX
Enumeration date
07/18/2006
Last updated
12/03/2019
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