Provider Demographics
NPI:1679559272
Name:MAHARAJH, BALKISSOON (MD)
Entity type:Individual
Prefix:DR
First Name:BALKISSOON
Middle Name:
Last Name:MAHARAJH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 FRANKLIN ST
Mailing Address - Street 2:LEVEL A
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905
Mailing Address - Country:US
Mailing Address - Phone:814-536-9715
Mailing Address - Fax:814-539-6138
Practice Address - Street 1:1015 FRANKLIN ST
Practice Address - Street 2:LEVEL A
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905
Practice Address - Country:US
Practice Address - Phone:814-536-9715
Practice Address - Fax:814-539-6138
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD051194L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014267380003Medicaid
PA054338Medicare ID - Type Unspecified
PA0014267380003Medicaid