Healthcare Provider Details

I. General information

NPI: 1174698542
Provider Name (Legal Business Name): DAVID A BALLAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 10/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 SHAKER RD
EAST LONGMEADOW MA
01028-2731
US

IV. Provider business mailing address

TRINITY HEALTH OF NE MED GRP - ATTN: PGREANEY 395 SOUTHAMPTON RD., #100
WESTFIELD MA
01085-1324
US

V. Phone/Fax

Practice location:
  • Phone: 413-525-1554
  • Fax: 413-525-7764
Mailing address:
  • Phone: 413-485-4663
  • Fax: 413-562-1605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number36805
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: