Provider Demographics
NPI:1619321171
Name:BALLONE, NINA THERESA (MD)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:THERESA
Last Name:BALLONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5255 LOUGHBORO RD NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-2696
Mailing Address - Country:US
Mailing Address - Phone:202-660-5225
Mailing Address - Fax:202-537-4737
Practice Address - Street 1:5255 LOUGHBORO RD NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-2696
Practice Address - Country:US
Practice Address - Phone:202-660-5225
Practice Address - Fax:202-537-4737
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-20
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00948392084P0015X
VA01012688702084P0015X, 2084P0800X
PAMD4660752084P0800X
DCMD2100023052084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry