1366410722 NPI number — PAMELA BALLARD MD

Table of content: PAMELA BALLARD MD (NPI 1366410722)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366410722 NPI number — PAMELA BALLARD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BALLARD
Provider First Name:
PAMELA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366410722
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/10/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 IRVING ST NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20010-2921
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 IRVING ST NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20010-2921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-877-1170
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  19091 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 112522 . This is a "KAISER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 411438 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7639069003 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 520846-01 . This is a "BS OF MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 5460-0036 . This is a "BS OF NCA" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 852241 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4398916 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 494959 . This is a "NCPPO" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com