Individual
DR. ENRIQUE BALLESTEROS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
263 FARMINGTON AVE, FARMINGTON, CT 06030-3985
(860) 679-2980
(860) 679-4334
Mailing address
263 FARMINGTON AVE, PROVIDER ENROLLMENT, FARMINGTON, CT 06030-2212
(860) 679-7503
(860) 679-1610
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
039969
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1972594497
—
CT
Enumeration date
11/03/2005
Last updated
11/07/2022
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