Individual
DR. SUELLEN TUCKER BALESTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
243 ELM ST, CLAREMONT, NH 03743-4921
(603) 542-7771
Mailing address
14 SEVENS RD, LEBANON, NH 03766
(603) 448-6140
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
6628
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000932
MEDICAID VT
VT
05
—
40200340
—
NH
Enumeration date
02/05/2007
Last updated
07/08/2007
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