Provider Demographics
NPI:1366443376
Name:BELANGER, KRISTEN ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:ANNE
Last Name:BELANGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1088 WASSERMAN WAY
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-1974
Mailing Address - Country:US
Mailing Address - Phone:513-735-8100
Mailing Address - Fax:
Practice Address - Street 1:1088 WASSERMAN WAY
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-1974
Practice Address - Country:US
Practice Address - Phone:513-735-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH073539207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64057391Medicaid
OH2351655Medicaid
IN200921680Medicaid
KY64057391Medicaid
KY3400152Medicare PIN
KY3313207Medicare PIN
OH2351655Medicaid
KYK187640Medicare PIN
KY0655076Medicare PIN