Healthcare Provider Details

I. General information

NPI: 1184801441
Provider Name (Legal Business Name): MARIANNE MULLIN BALLISTY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIANNE MULLIN MD

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 02/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

534 BILTMORE AVE
ASHEVILLE NC
28801-4612
US

IV. Provider business mailing address

PO BOX 1987
INDIANAPOLIS IN
46206-1987
US

V. Phone/Fax

Practice location:
  • Phone: 828-213-0801
  • Fax:
Mailing address:
  • Phone: 828-253-3322
  • Fax: 828-253-1895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2012-01127
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: