Healthcare Provider Details

I. General information

NPI: 1992957294
Provider Name (Legal Business Name): KEVIN BALL PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2008
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 CARE LN
SARATOGA SPRINGS NY
12866-8623
US

IV. Provider business mailing address

121 EVERETT RD
ALBANY NY
12205-1474
US

V. Phone/Fax

Practice location:
  • Phone: 518-489-2663
  • Fax:
Mailing address:
  • Phone: 518-489-2663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number012557
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: