Individual
DR. DOUGLAS A. BALLAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
45 ELM AVE, THIS IS DOCTOR'S HOME; THERE IS NO OFFICE., FANWOOD, NJ 07023-1203
(908) 279-3477
(908) 345-6111
Mailing address
PO BOX 122, SCOTCH PLAINS, NJ 07076-0122
(908) 279-3477
(908) 345-6111
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MA57331
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
733566
MEDICARE PTAN
—
Enumeration date
06/27/2006
Last updated
09/06/2011
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