Individual
MR. ROBERT BALLOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
94 CONNECTICUT BLVD, EAST HARTFORD, CT 06108-3013
(860) 528-1359
Mailing address
4 FARM CT, WALLINGFORD, CT 06492-3251
(203) 376-1863
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
002079
CT
Other
Enumeration date
06/12/2008
Last updated
04/30/2024
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