Provider Demographics
NPI:1306194170
Name:BALLA, RICHIE (HHA)
Entity Type:Individual
Prefix:
First Name:RICHIE
Middle Name:
Last Name:BALLA
Suffix:
Gender:M
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3624 PEAR TREE CT APT 32
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-5516
Mailing Address - Country:US
Mailing Address - Phone:240-893-0234
Mailing Address - Fax:
Practice Address - Street 1:855 21ST ST NE APT 1
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-4140
Practice Address - Country:US
Practice Address - Phone:202-500-3001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor