Healthcare Provider Details

I. General information

NPI: 1285952937
Provider Name (Legal Business Name): DARRELL FITZGERALD BALLINGER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2010
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6438 WILMINGTON PIKE STE 125
CENTERVILLE OH
45459-7033
US

IV. Provider business mailing address

1 PRESTIGE PL STE 550
MIAMISBURG OH
45342-6115
US

V. Phone/Fax

Practice location:
  • Phone: 937-458-0085
  • Fax: 937-458-0212
Mailing address:
  • Phone: 937-762-1309
  • Fax: 937-522-8940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36.003657
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36003657
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number36.003657
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: