Provider Demographics
NPI:1205809407
Name:BALL, DAVID JOSEPH (DO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JOSEPH
Last Name:BALL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 COLUMBIA BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-8804
Mailing Address - Country:US
Mailing Address - Phone:570-387-2282
Mailing Address - Fax:570-387-2287
Practice Address - Street 1:2701 COLUMBIA BLVD
Practice Address - Street 2:STE A
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-8804
Practice Address - Country:US
Practice Address - Phone:570-387-2282
Practice Address - Fax:570-387-2287
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006155L2085R0202X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015666770008Medicaid
PA0015666770009Medicaid
PA0015666770008Medicaid
C34001Medicare UPIN