Provider Demographics
NPI:1811095771
Name:BALLENGER, CYNTHIA ANN (MD)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ANN
Last Name:BALLENGER
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 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:514 N BRIGHTLEAF BLVD STE 1200
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4486
Practice Address - Country:US
Practice Address - Phone:919-209-3555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101 2300802085R0001X
GA0519072085R0001X
NC96-015552085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC205504OtherMEDCOST
NCP00612671OtherRAILROAD MEDICARE
NC8912773Medicaid
NC8373963OtherCIGNA
NC12773OtherBCBS
NC7331362OtherAETNA
NCP01619309OtherRR MEDICARE
NC1811095771Medicaid
NC205504OtherMEDCOST
NC2281603BMedicare PIN
NCP01619309OtherRR MEDICARE
NCH2964Medicare UPIN