Provider Demographics
NPI:1669404661
Name:BALLENTYNE, MARK A (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:BALLENTYNE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:100 GRIFFIN ROAD
Mailing Address - Street 2:SUITE B
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801
Mailing Address - Country:US
Mailing Address - Phone:603-431-8819
Mailing Address - Fax:603-427-2540
Practice Address - Street 1:100 GRIFFIN ROAD
Practice Address - Street 2:ATLANTIC PLASTIC SURGERY SUITE B
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801
Practice Address - Country:US
Practice Address - Phone:603-431-8819
Practice Address - Fax:603-427-2540
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NH8856207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E69139Medicare UPIN