DR. KHADIJAT OMOLOLA BALOGUN (NPI# 1124310743) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124310743 |
| Entity Type | Individual |
| Full Name | DR. KHADIJAT OMOLOLA BALOGUN |
| Credential | M.D |
| Practice Address |
353 Main St Manchester CT 06040-4145 |
| Practice Telephone | (860) 649-3477 |
| Practice Fax Number | 8606490011 |
| Mailing Telephone | (860) 649-3477 |
| Mailing Fax Number | 8606490011 |
| Enumeration Date | 2011-05-16 |
| Last Update Date | 2017-07-26 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RG0100X |
Internal Medicine Specialization: Gastroenterology |
56518 | CT | Allopathic & Osteopathic Physicians |
| Street Address |
353 MAIN ST |
| City | MANCHESTER |
| State | CT |
| Zip Code | 06040-4145 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841275252 | James W O'brien | Internal Medicine | 353 Main St, Manchester, CT 06040-4145 | 2005-12-08 |
| 1326562828 | Meghan Tetreault | Nurse Practitioner | 353 Main St, Manchester, CT 06040-4145 | 2017-07-27 |
| 1194168476 | Lauren Ann Baltrucki | Nurse Practitioner | 353 Main St, Manchester, CT 06040-4145 | 2013-04-17 |
| 1447533534 | Nicole Christine Tino | Physician Assistant | 353 Main St, Manchester, CT 06040-4145 | 2011-09-24 |
| 1992924906 | Irm Khan | Physician Assistant | 353 Main St, Manchester, CT 06040-4145 | 2007-04-25 |
| 1164541686 | Digestive Health Specialists of Eastern Connecticut LLC | Internal Medicine | 353 Main St, Manchester, CT 06040-4145 | 2007-03-28 |
| 1811099104 | Amer Skopic | Internal Medicine | 353 Main St, Manchester, CT 06040-4145 | 2006-09-05 |
| 1124098199 | Peter S Buch | Internal Medicine | 353 Main St, Manchester, CT 06040-4145 | 2006-01-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710501333 | Mackenzie Lawler | Social Worker | 200 W. Center Street, Suite C-2-6, Manchester, CT 06040 | 2020-05-29 |
| 1386288009 | Monica Diaz | Social Worker | 117 East Center Street, Suite A1, Manchester, CT 06040 | 2019-11-06 |
| 1346881596 | Sheryl Andrine Henry | Technician | 185 Pine Street, Apt 014, Manchester, CT 06040 | 2019-09-30 |
| 1811550304 | Edward Wahn Lee | Student in an Organized Health Care Education/Training Program | 130 Hartford Road, Manchester, CT 06040 | 2019-04-19 |
| 1538689534 | Bernard Ashirifie | Counselor | 869 Main Street, Apt 3, Manchester, CT 06040 | 2017-06-21 |
| 1497275697 | Justin David Chung | Dentist | 483 Middle Tpke W Ste 209, Manchester, CT 06040 | 2017-06-20 |
| 1114473436 | Amanda Edgar | Counselor | 469 Center Street, Manchester, CT 06040 | 2016-08-28 |
| 1760831366 | Samantha Micael | Marriage & Family Therapist | 200 West Center Street, Suite C-2-6, Manchester, CT 06040 | 2016-06-06 |
| 1962856179 | Odelia Brew | Nurse Practitioner | 256 Hackmatack Street, Manchester, CT 06040 | 2016-04-14 |
| 1306217765 | Stephen R Machattie | Social Worker | 843 Main St Ste 11, Manchester, CT 06040 | 2015-10-12 |
| Find all providers in zip 06040 | ||||
| Taxonomy Code | 207RG0100X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Gastroenterology |
| An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841275252 | James W O'brien | Internal Medicine | 353 Main St, Manchester, CT 06040-4145 | 2005-12-08 |
| 1992700702 | Stephen M. Wiener | Internal Medicine | 185 Queen City Ave, Manchester, NH 03101-7121 | 2005-06-17 |
| 1902197353 | Keri Lee Pinnock | Internal Medicine | 71 Haynes St, Manchester, CT 06040 | 2011-04-20 |
| 1407161151 | Elliot Professional Services | Internal Medicine | 185 Queen City Ave, Elliot Gastroenterology, Manchester, NH 03101-7100 | 2010-08-18 |
| 1235450792 | Dmitriy Kedrin | Internal Medicine | 185 Queen City Ave, Elliot Gastroenterology, Manchester, NH 03101-7121 | 2010-06-18 |
| 1164541686 | Digestive Health Specialists of Eastern Connecticut LLC | Internal Medicine | 353 Main St, Manchester, CT 06040-4145 | 2007-03-28 |
| 1902935620 | Greater Manchester Gastroenterology | Internal Medicine | 88 Mcgregor St, Suite 302, Manchester, NH 03102-3750 | 2007-03-06 |
| 1093842130 | Klipstein Medical Group PC | Internal Medicine | 272 Main St, Manchester, CT 06042-3536 | 2007-02-27 |
| 1548396211 | Vincent Aguirre | Internal Medicine | 185 Queen City Ave, Manchester, NH 03101-7121 | 2007-02-26 |
| 1164563268 | Trinh Bang Meyer | Internal Medicine | 100 Hitchcock Way, Manchester, NH 03104-4125 | 2007-02-09 |
| Find all providers in MANCHESTER | ||||
| City | MANCHESTER |
| Zip Code | 06040 |
Please comment or provide details below to improve the information on DR. KHADIJAT OMOLOLA BALOGUN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.