Individual
MANGALAM BALA
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2300 BUFFALO RD, BLDG. 200, ROCHESTER, NY 14624-1360
(585) 368-6370
(585) 368-3671
Mailing address
2300 BUFFALO RD, BLDG. 200, ROCHESTER, NY 14624-1360
(585) 368-6370
(585) 368-3671
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
190510
NY
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
190510
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000911377002
HEALTHNOW
NY
05
—
01674015
—
NY
01
—
102721BJ
PREFERRED CARE
NY
01
—
190510-8W
WORKER'S COMPENSATION
NY
01
—
7559019
AETNA
NY
Enumeration date
06/16/2006
Last updated
09/11/2025
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