Provider Demographics
NPI:1902990443
Name:BALLET, FREDERICK L (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:L
Last Name:BALLET
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 1:7000 ATRIUM WAY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054
Mailing Address - Country:US
Mailing Address - Phone:856-206-4500
Mailing Address - Fax:856-234-4241
Practice Address - Street 1:5000 SAGEMORE DRIVE
Practice Address - Street 2:SUITE 103
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053
Practice Address - Country:US
Practice Address - Phone:856-983-4263
Practice Address - Fax:856-983-9362
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA41767174400000X, 2086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1245286OtherUNITED HEALTHCARE
NJBNS014OtherOXFORD
NJ3733521BOtherCIGNA
NJ0001480000OtherAMERIHEALTH
NJ0041165OtherGHI
NJ010272400OtherKEYSTONE
NJ157009OtherGREAT WEST
NJ2K1490OtherHEALTHNET
NJ4090690OtherAETNA
NJ6567F02205Other1STOPTION
NJ1245286OtherUNITED HEALTHCARE
NJ0001480000OtherAMERIHEALTH