Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 0101056727 | VA |
Y | 207V00000X | Obstetrician & Gynecologist | G62297 | CA |
N | 207VE0102X | Reproductive Endocrinologist | 0101056727 | VA |
NPI | 1245201201 |
---|---|
Provider Name | Dr. Susan Aucott Ballagh |
First Address | Torrance, CA 90502-2004 |
Second Address | Torrance, CA 90502-2004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2006 |
Last Update Date | 11/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
006210724 | (05) | VA |
0612M | NC BC/BS (01) | NC |
332690 | ANTHEM (01) | VA |
351316 | UHC/MAMSI (01) | |
56588 | SENTARA (01) | VA |
790612M | (05) | NC |
F40551 | (02) | VA |