Provider Demographics
NPI:1538127097
Name:BALL, MARQUITA HANNA (MD)
Entity Type:Individual
Prefix:
First Name:MARQUITA
Middle Name:HANNA
Last Name:BALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 HELMWOOD PLAZA DRIVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701
Mailing Address - Country:US
Mailing Address - Phone:270-737-4808
Mailing Address - Fax:270-737-4939
Practice Address - Street 1:111 HELMWOOD PLAZA DRIVE
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701
Practice Address - Country:US
Practice Address - Phone:270-737-4808
Practice Address - Fax:270-737-4939
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY29479208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000051746OtherBLUE CROSS
KY1048728OtherPASSPORT
KY64294796Medicaid
F62781Medicare UPIN