Provider Demographics
NPI:1154416774
Name:BALLARD, HARLOW G III (MD)
Entity type:Individual
Prefix:DR
First Name:HARLOW
Middle Name:G
Last Name:BALLARD
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:250 MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602-4257
Mailing Address - Country:US
Mailing Address - Phone:802-223-2228
Mailing Address - Fax:802-778-0278
Practice Address - Street 1:250 MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-4257
Practice Address - Country:US
Practice Address - Phone:802-223-2228
Practice Address - Fax:802-778-0278
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2011-03-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VT4200096272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN1711Medicaid
VTOVN1711Medicaid
G41836Medicare UPIN