Healthcare Provider Details

I. General information

NPI: 1447545413
Provider Name (Legal Business Name): MICHELLE T BALLENTYNE-HYATT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2011
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

734 N FRANKLIN ST
LANCASTER PA
17602-2176
US

IV. Provider business mailing address

734 N FRANKLIN ST
LANCASTER PA
17602-2176
US

V. Phone/Fax

Practice location:
  • Phone: 717-295-2323
  • Fax:
Mailing address:
  • Phone: 717-295-2323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number200168
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: