Individual
PERCY BALLANTINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
ANNA MARSH LANE, BRATTLEBORO, VT 05302-0803
(802) 257-7785
Mailing address
ANNA MARSH LANE, BRATTLEBORO, VT 05302-0803
(802) 257-7785
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
042-0005715
VT
2084P0800X
Psychiatry Physician
Primary
042-0005715
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
VT 0006779
—
VT
Enumeration date
10/05/2005
Last updated
03/17/2009
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