1902990443 NPI number — DR. FREDERICK L BALLET MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902990443 NPI number — DR. FREDERICK L BALLET MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

BALLET

Provider First Name:

FREDERICK

Provider Middle Name:

L

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

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:

1902990443

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

02/24/2017

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

7000 ATRIUM WAY

Provider Second Line Business Mailing Address:

SUITE 6

Provider Business Mailing Address City Name:

MOUNT LAUREL

Provider Business Mailing Address State Name:

NJ

Provider Business Mailing Address Postal Code:

08054

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

856-206-4500

Provider Business Mailing Address Fax Number:

856-234-4241

Provider First Line Business Practice Location Address:

5000 SAGEMORE DRIVE

Provider Second Line Business Practice Location Address:

SUITE 103

Provider Business Practice Location Address City Name:

MARLTON

Provider Business Practice Location Address State Name:

NJ

Provider Business Practice Location Address Postal Code:

08053

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

856-983-4263

Provider Business Practice Location Address Fax Number:

856-983-9362

Provider Enumeration Date:

10/02/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 174400000X , with the licence number:  MA41767 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2086S0105X , with the licence number: MA41767 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 1245286 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: BNS014 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 3733521B . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 0001480000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 0041165 . This is a "GHI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 010272400 . This is a "KEYSTONE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 157009 . This is a "GREAT WEST" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 2K1490 . This is a "HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 4090690 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 6567F02205 . This is a "1STOPTION" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".