Provider Demographics
NPI:1457819526
Name:BALLAH, RHODA
Entity Type:Individual
Prefix:MRS
First Name:RHODA
Middle Name:
Last Name:BALLAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12907 CLEARFIELD DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-1106
Mailing Address - Country:US
Mailing Address - Phone:240-486-0199
Mailing Address - Fax:301-805-0195
Practice Address - Street 1:12907 CLEARFIELD DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1106
Practice Address - Country:US
Practice Address - Phone:240-486-0199
Practice Address - Fax:301-805-0195
Is Sole Proprietor?:No
Enumeration Date:2019-03-07
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR204861363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner