Provider Demographics
NPI:1427870583
Name:BALLARD BEY, DEMETRIA BALLARD
Entity type:Individual
Prefix:
First Name:DEMETRIA
Middle Name:BALLARD
Last Name:BALLARD BEY
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 1:5204 TIPPERARY AVE
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602
Mailing Address - Country:US
Mailing Address - Phone:301-752-3482
Mailing Address - Fax:
Practice Address - Street 1:1100 1ST ST SE APT 317
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-4706
Practice Address - Country:US
Practice Address - Phone:202-390-9110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide