Provider Demographics
NPI:1568433365
Name:BALL, JOHN D (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:BALL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-8400
Mailing Address - Fax:757-446-8401
Practice Address - Street 1:721 FAIRFAX AVE
Practice Address - Street 2:SUITE 461
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-2007
Practice Address - Country:US
Practice Address - Phone:757-446-8400
Practice Address - Fax:757-446-8401
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810000976103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA-006OtherTRICARE/CHAMPUS
VA031141OtherVALUE OPTIONS
VA007726759Medicaid
VAPAROtherUNITED BEHAVIORAL HEALTH
VAPAROtherAETNA
VAPAROtherCIGNA BEHAVIORAL HEALTH
VA133033OtherMANAGED HEALTH NETWORK
VAPAROtherVIRGINIA PREMIER HEALTH
100024679OtherAPS
VAPAROtherUSA MANAGED CARE
VAPAROtherCORVEL/CORCARE
VA215683OtherUHC/MAMSI
VA87210OtherSENTARA/OPTIMA
VAPAROtherFIRST HEALTH COMMERCIAL
VA081890OtherANTHEM
NC12835OtherBC/BS
VA226230OtherMAGELLAN
VAPAROtherVIRGINIA HEALTH NETWORK
VAPAROtherMULTIPLAN
VAPAROtherVIRGINIA HEALTH NETWORK
VA226230OtherMAGELLAN
VA680004100Medicare PIN