Provider Demographics
NPI:1447581897
Name:BALL, ADAM (DC STUDENT)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:BALL
Suffix:
Gender:M
Credentials:DC STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 SLATE CREEK DR
Mailing Address - Street 2:UNIT 9
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14227-2860
Mailing Address - Country:US
Mailing Address - Phone:315-406-3048
Mailing Address - Fax:
Practice Address - Street 1:86 SLATE CREEK DR
Practice Address - Street 2:UNIT 9
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14227-2860
Practice Address - Country:US
Practice Address - Phone:315-406-3048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-25
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program