MEDICARE: MR. JOHN RICH BALENTINE III PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1164493268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN RICH BALENTINE III PA-C

Provider Business Mailing Address
First Line	:	501 DISCOVERY DR
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23320-3843
Country	:	US
Telephone Number	:	757-547-5145
Fax Number	:	757-312-0216

Provider Business Practice Location Address
First Line	:	150 BURNETTS WAY STE 100
Second Line	:
City	:	SUFFOLK
State	:	VA
Zip	:	23434-8168
Country	:	US
Telephone Number	:	757-547-5145
Fax Number	:	757-539-7488

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2006
Last Update Date	:	02/04/2021

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