Provider Demographics
NPI:1962516468
Name:BALLARD, HARRY HAMPTON (MD)
Entity type:Individual
Prefix:DR
First Name:HARRY
Middle Name:HAMPTON
Last Name:BALLARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 NEWMAN RD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-5239
Mailing Address - Country:US
Mailing Address - Phone:252-633-2081
Mailing Address - Fax:
Practice Address - Street 1:701 NEWMAN RD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5239
Practice Address - Country:US
Practice Address - Phone:252-633-2081
Practice Address - Fax:252-633-3446
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21247208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8912855Medicaid
NC12855OtherBLUE CROSS BLUE SHIELD
NCC87375Medicare UPIN
NC8912855Medicaid