Basic Information
| Provider Information | |||||||||
| NPI: | 1811095771 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BALLENGER | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2234 COLONIAL BLVD | ||||||||
| Address2: | ATTN: PAYER CONTRACTING & RELATIONS | ||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339071412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2399317342 | ||||||||
| FaxNumber: | 2399317385 | ||||||||
| Practice Location | |||||||||
| Address1: | 514 N BRIGHTLEAF BLVD STE 1200 | ||||||||
| Address2: | |||||||||
| City: | SMITHFIELD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275774486 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192093555 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2006 | ||||||||
| LastUpdateDate: | 03/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 0101 230080 | VA | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | 051907 | GA | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | 96-01555 | NC | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 205504 | 01 | NC | MEDCOST | OTHER | P00612671 | 01 | NC | RAILROAD MEDICARE | OTHER | 8912773 | 05 | NC | MEDICAID | 8373963 | 01 | NC | CIGNA | OTHER | 12773 | 01 | NC | BCBS | OTHER | 7331362 | 01 | NC | AETNA | OTHER | P01619309 | 01 | NC | RR MEDICARE | OTHER | 1811095771 | 05 | NC | MEDICAID |