Provider Demographics
NPI:1700883212
Name:BALLANCE, WILLIAM A JR (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:A
Last Name:BALLANCE
Suffix:JR
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 1:2515 BOWMAN GRAY DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-7215
Mailing Address - Country:US
Mailing Address - Phone:252-561-7992
Mailing Address - Fax:252-561-7993
Practice Address - Street 1:2515 BOWMAN GRAY DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7215
Practice Address - Country:US
Practice Address - Phone:252-561-7992
Practice Address - Fax:252-561-7993
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31960207ZP0102X, 207ZC0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8912846Medicaid
NC1117UOtherBCBS
NC220025283OtherRR MEDICARE
NC11-55226OtherUNITED HEALTHCARE
NC78865OtherMEDCOST
NC220025283OtherRR MEDICARE
2156918AMedicare PIN