Provider Demographics
NPI:1447287636
Name:BALOG, CARL CSABA (MD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:CSABA
Last Name:BALOG
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 SW JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-2548
Mailing Address - Country:US
Mailing Address - Phone:503-887-2209
Mailing Address - Fax:888-894-1774
Practice Address - Street 1:1410 SW JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-2548
Practice Address - Country:US
Practice Address - Phone:503-887-2209
Practice Address - Fax:888-894-1774
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD19519207L00000X, 207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR074062Medicaid
130869Medicare PIN
F96465Medicare UPIN