Provider Demographics
NPI:1134207244
Name:BALLARD, ELLEN MARGARET (MD)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:MARGARET
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 1:1941 BISHOP LN STE 402
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-1922
Mailing Address - Country:US
Mailing Address - Phone:502-456-2677
Mailing Address - Fax:502-458-2163
Practice Address - Street 1:1941 BISHOP LN STE 402
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-1922
Practice Address - Country:US
Practice Address - Phone:502-458-2677
Practice Address - Fax:502-458-2163
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26543208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY373344400OtherDOL
KY1127947OtherPASSPORT HEALTH
KY000000174219OtherANTHEM
KY5729195OtherAETNA
KY1127947OtherPASSPORT HEALTH
KY373344400OtherDOL