Provider Demographics
NPI:1730134859
Name:BALLARD, JEANNE ELLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:ELLEN
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 1:620 SEAWARD DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-8942
Mailing Address - Country:US
Mailing Address - Phone:843-261-4092
Mailing Address - Fax:317-853-6198
Practice Address - Street 1:3401 E RAYMOND ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46203-4744
Practice Address - Country:US
Practice Address - Phone:317-781-4900
Practice Address - Fax:317-781-4868
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045341A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200099420AMedicaid
238760HMedicare ID - Type Unspecified
IN200099420AMedicaid