Provider Demographics
NPI:1881789402
Name:BALLARD, REBECCA ANN (MD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:ANN
Last Name:BALLARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:ANN
Other - Last Name:LUBELCZYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:139 GRANT STREET
Mailing Address - Street 2:
Mailing Address - City:NORTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02760
Mailing Address - Country:US
Mailing Address - Phone:508-699-5746
Mailing Address - Fax:
Practice Address - Street 1:28 CLARK STREET
Practice Address - Street 2:BAY STATE CORRECTIONAL CENTER
Practice Address - City:NORFOLK
Practice Address - State:MA
Practice Address - Zip Code:02056
Practice Address - Country:US
Practice Address - Phone:508-668-1687
Practice Address - Fax:508-660-1019
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA208221207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine