Suellen Tucker Balestra, MD

Key facts

NPI

1295874493

Entity type

Individual (NPI type 1)

Primary specialty

Anatomic Pathology & Clinical Pathology Physician 207ZP0102X

License

6628 (NH)

Practice address

243 Elm St
Claremont, NH 03743-4921

Phone

(603) 542-7771

NPI assigned

Feb 5, 2007

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Medicine

State licenses

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "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": []
}

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• Zuha Bajwa, PHARMD
• Erik Baker
• Todd Balise
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• Dia Ballou
• Bannon Pharmacy Inc
• Carl Jay Bannon

All providers in Claremont, NH · Anatomic Pathology & Clinical Pathology Physician in New Hampshire