Provider Demographics
NPI:1679561401
Name:BALLARD, BETSY (MD)
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:
Last Name:BALLARD
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 1:10301 GEORGIA AVE
Mailing Address - Street 2:SUITE # 104
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-5020
Mailing Address - Country:US
Mailing Address - Phone:301-681-7310
Mailing Address - Fax:301-681-6975
Practice Address - Street 1:10301 GEORGIA AVE
Practice Address - Street 2:104
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-5020
Practice Address - Country:US
Practice Address - Phone:301-681-7310
Practice Address - Fax:301-681-6975
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD 29018208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC735901YA6KMedicare PIN
MDF13240Medicare UPIN