Individual
FRED JACKSON BALLENGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2602 FRANKLIN RD SW, ROANOKE, VA 24014-1010
(540) 344-1400
(540) 344-7133
Mailing address
2602 FRANKLIN RD SW, ROANOKE, VA 24014-1010
(540) 344-1400
(540) 344-7133
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
0101027649
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6091270
—
VA
01
—
CG1162
RR MEDICARE GROUP
VA
Enumeration date
07/12/2005
Last updated
03/29/2021
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