Provider Demographics
NPI:1982076394
Name:BALLOU, WILLIAM RIPLEY JR
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:RIPLEY
Last Name:BALLOU
Suffix:JR
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 1:14200 SHADY GROVE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-7464
Mailing Address - Country:US
Mailing Address - Phone:301-204-4062
Mailing Address - Fax:
Practice Address - Street 1:14200 SHADY GROVE RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-7464
Practice Address - Country:US
Practice Address - Phone:301-204-4062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-25
Last Update Date:2015-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0030157207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease