Organization
ADVANCED FOOT AND ANKLE SPECIALISTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RACHEL ELISE BALLOCH MD (PRESIDENT)
(860) 674-0284
Entity
Organization
Contact information
Practice address
100 SIMSBURY RD STE 209, AVON, CT 06001-3793
(860) 674-0284
Mailing address
100 SIMSBURY RD STE 209, AVON, CT 06001-3793
(860) 674-0284
(860) 674-0292
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000850
CONNECTICUT MEDICAL BOARD
CT
Enumeration date
08/06/2019
Last updated
11/02/2020
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