Provider Demographics
NPI:1659400943
Name:BALLOU, CHRISTOPHER BUCKINGHAM (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:BUCKINGHAM
Last Name:BALLOU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7430 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-2903
Mailing Address - Country:US
Mailing Address - Phone:839-200-7810
Mailing Address - Fax:803-891-7085
Practice Address - Street 1:7430 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-2903
Practice Address - Country:US
Practice Address - Phone:839-200-7810
Practice Address - Fax:803-891-7085
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27974208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC279745Medicaid
SCAA38237579Medicare PIN
SCSC22719615Medicare PIN