Individual
ASHFAQ S. BALLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 LAKE AVE N, WORCESTER, MA 01655-0002
(508) 856-3155
(508) 856-3111
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
(800) 225-8885
(508) 334-1977
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
242372
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110084568A
—
MA
Enumeration date
06/04/2006
Last updated
11/17/2020
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