Provider Demographics
NPI:1841009040
Name:BALLOU, DEMESHA
Entity type:Individual
Prefix:
First Name:DEMESHA
Middle Name:
Last Name:BALLOU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6567 HIL MAR DR
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-4134
Mailing Address - Country:US
Mailing Address - Phone:202-849-0895
Mailing Address - Fax:
Practice Address - Street 1:4530 WISCONSIN AVE NW STE 300
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-4606
Practice Address - Country:US
Practice Address - Phone:202-536-4414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator