Basic Information
| Provider Information | |||||||||
| NPI: | 1447545413 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BALLENTYNE-HYATT | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 734 N FRANKLIN ST | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176022176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172952323 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 734 N FRANKLIN ST | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176022176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172952323 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2011 | ||||||||
| LastUpdateDate: | 10/01/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 200168 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | MD451685 | 01 | PA | MEDICAL LICENSE | OTHER | 232687271 | 01 | PA | TAX ID | OTHER |