Provider Demographics
NPI:1043306392
Name:BALLAY, CHARLES JOSEPH II (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:JOSEPH
Last Name:BALLAY
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 MEDICAL CENTER BLVD
Mailing Address - Street 2:SUITE 707 N
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3148
Mailing Address - Country:US
Mailing Address - Phone:504-934-8550
Mailing Address - Fax:504-934-8549
Practice Address - Street 1:1111 MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE 707N
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3148
Practice Address - Country:US
Practice Address - Phone:504-934-8550
Practice Address - Fax:504-934-8549
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94147174400000X
TXM6514207Y00000X
LA205801207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2351753Medicaid