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General NPI Number Information
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NPI Number | 1740235720
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Entity Type | Individual
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Provider Name | CAROLYN OATES BALLANTINE M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/24/2006
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Last Update Date | 06/06/2008
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Provider Practice Location Address
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Address Line | 508 FULTON ST DURHAM VAMC, MAIL CODE 116-A
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City | DURHAM
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State | NC
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Zip | 27705-3875
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Country | US
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Telephone | 919-212-3011
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Fax | 919-255-1540
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Provider Business Mailing Address
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Address Line | 8804 WELLSLEY WAY
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City | RALEIGH
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State | NC
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Zip | 27613-1358
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Country | US
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Telephone | 919-593-5548
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Fax | 919-929-8900
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 200201134
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License Number State | NC
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