1649427436 NPI number — CAROLYN O. BALLANTINE, MD. PLLC

Table of content: (NPI 1649427436)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649427436 NPI number — CAROLYN O. BALLANTINE, MD. PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROLYN O. BALLANTINE, MD. PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649427436
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1709 LEGION RD
Provider Second Line Business Mailing Address:
SUITE 224
Provider Business Mailing Address City Name:
CHAPEL HILL
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27517-2375
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-593-5548
Provider Business Mailing Address Fax Number:
919-929-8900

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1709 LEGION RD
Provider Second Line Business Practice Location Address:
SUITE 224
Provider Business Practice Location Address City Name:
CHAPEL HILL
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27517-2375
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-593-5548
Provider Business Practice Location Address Fax Number:
919-929-8900
Provider Enumeration Date:
08/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BALLANTINE
Authorized Official First Name:
CAROLYN
Authorized Official Middle Name:
OATES
Authorized Official Title or Position:
SOLE MEMBER/ORGANIZER
Authorized Official Telephone Number:
919-593-5548

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  200201134 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com