Individual
DR. SAMUEL JAMES BALLENTINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1290 SILAS DEANE HWY STE 101, WETHERSFIELD, CT 06109-4337
(860) 859-9061
(860) 889-6200
Mailing address
PO BOX 7412011, CHICAGO, IL 60674-2011
(314) 362-5641
(314) 362-8950
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
2019024601
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200071078
—
MO
Enumeration date
04/22/2013
Last updated
12/29/2025
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