Individual
LORI W. BALABAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1011 E JEFFERSON ST, CHARLOTTESVILLE, VA 22902-5354
(434) 296-9161
(434) 977-6068
Mailing address
1011 E JEFFERSON ST, CHARLOTTESVILLE, VA 22902-5354
(434) 296-9161
(434) 977-6068
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0101049502
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006725813
—
VA
01
—
010712
CIGNA
VA
01
—
12952600002
SOUTHERN HEALTH
VA
01
—
267039
MAMSI/ALLIANCE
VA
01
—
333846
ANTHEM
VA
01
—
52387
VETRI
VA
Enumeration date
11/18/2005
Last updated
09/29/2012
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