Healthcare Provider Details

I. General information

NPI: 1306194170
Provider Name (Legal Business Name): RICHIE BALLA HHA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2012
Last Update Date: 08/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 21ST ST NE APT 1
WASHINGTON DC
20002-4140
US

IV. Provider business mailing address

3624 PEAR TREE CT APT 32
SILVER SPRING MD
20906-5516
US

V. Phone/Fax

Practice location:
  • Phone: 202-500-3001
  • Fax:
Mailing address:
  • Phone: 240-893-0234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: