Individual
DR. EDWARD JAMES BALLANTINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
56 KINGSBORO AVE, GLOVERSVILLE, NY 12078-3411
(518) 725-8834
Mailing address
56 KINGSBORO AVE, GLOVERSVILLE, NY 12078-3411
(518) 725-8834
(518) 773-8551
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
130238-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00553484
—
NY
Enumeration date
07/25/2006
Last updated
12/20/2011
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