Active NPI
Suellen Tucker Balestra, MD
- Anatomic Pathology & Clinical Pathology Physician
- Claremont, NH
National Provider Identifier
1295874493
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- 6628
- Practice address
- 243 Elm St
Claremont, NH 03743-4921 - Phone
- (603) 542-7771
- NPI assigned
- Feb 5, 2007
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 6628 | NH | Primary |
Addresses
Primary practice location
243 Elm St
Claremont, NH 03743-4921
Mailing address
14 Sevens Rd
Lebanon, NH 03766
Phone (603) 448-6140
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40200340 | Medicaid | NH | |
| 0000932 | Other | VT | MEDICAID VT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6628 | NH | MD | Anatomic Pathology & Clinical Pathology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170633600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1295874493",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14 SEVENS RD",
"city": "LEBANON",
"state": "NH",
"postal_code": "03766",
"telephone_number": "603-448-6140"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "243 ELM ST",
"city": "CLAREMONT",
"state": "NH",
"postal_code": "037434921",
"telephone_number": "603-542-7771"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BALESTRA",
"first_name": "SUELLEN",
"middle_name": "TUCKER",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "NH",
"license": "6628",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40200340",
"state": "NH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAID VT",
"identifier": "0000932",
"state": "VT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Claremont, NH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.