Provider Demographics
NPI:1740235720
Name:BALLANTINE, CAROLYN OATES (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:OATES
Last Name:BALLANTINE
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 1:8804 WELLSLEY WAY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-1358
Mailing Address - Country:US
Mailing Address - Phone:919-593-5548
Mailing Address - Fax:919-929-8900
Practice Address - Street 1:508 FULTON ST
Practice Address - Street 2:DURHAM VAMC, MAIL CODE 116-A
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3875
Practice Address - Country:US
Practice Address - Phone:919-212-3011
Practice Address - Fax:919-255-1540
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2002011342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1396XOtherBCBS NC
NC2043076Medicare ID - Type Unspecified
NC1396XOtherBCBS NC