Provider Demographics
NPI:1972855799
Name:BALL, COREY MATTHEW
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:MATTHEW
Last Name:BALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 HOMESTEAD RD APT 1209
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-8758
Mailing Address - Country:US
Mailing Address - Phone:919-306-6276
Mailing Address - Fax:
Practice Address - Street 1:2701 HOMESTEAD RD APT 1209
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27516-8758
Practice Address - Country:US
Practice Address - Phone:919-306-6276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program