Individual
CONSTANTINE A BALOURIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
102 TECHNOLOGY DR, SUITE 120, BUTLER, PA 16001-1782
(724) 482-0090
(724) 482-0093
Mailing address
102 TECHNOLOGY DR, SUITE 120, BUTLER, PA 16001-1782
(724) 482-0090
(724) 482-0093
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
BB4299447
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0016271000005
—
PA
01
—
1186970001
DME
PA
01
—
PO38282-A003
CHAMPUS
PA
Enumeration date
11/01/2006
Last updated
07/08/2007
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