Provider Demographics
NPI:1952300063
Name:BALLENGER, RALPH R (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:R
Last Name:BALLENGER
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 1:750 MOUNT CARMEL MALL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43222-1553
Mailing Address - Country:US
Mailing Address - Phone:614-434-2400
Mailing Address - Fax:614-434-2499
Practice Address - Street 1:750 MOUNT CARMEL MALL
Practice Address - Street 2:SUITE 100
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222-1553
Practice Address - Country:US
Practice Address - Phone:614-434-2400
Practice Address - Fax:614-434-2499
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35029201207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0173057Medicaid
OHA71225Medicare UPIN
OHBA0143335Medicare ID - Type Unspecified6075 E. BROAD ST ID
OHBA0143333Medicare ID - Type Unspecified750 MT CARMEL MALL ID
OHBA0143334Medicare ID - Type Unspecified3750 RIDGE MILL DR ID