Healthcare Provider Details

I. General information

NPI: 1437366374
Provider Name (Legal Business Name): RYAN LEE BALLUM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 WESTHAMPTON WAY, SPECIAL PROGRAMS BUILDING UNIVERSITY OF RICHMOND STUDENT HEALTH CENTER
RICHMOND VA
23173
US

IV. Provider business mailing address

28 WESTHAMPTON WAY, SPECIAL PROGRAMS BUILDING UNIVERSITY OF RICHMOND STUDENT HEALTH CENTER
RICHMOND VA
23173
US

V. Phone/Fax

Practice location:
  • Phone: 804-289-8064
  • Fax: 804-287-6466
Mailing address:
  • Phone: 804-289-8064
  • Fax: 804-287-6466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101241773
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number0101241773
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: