Provider Demographics
NPI:1205652385
Name:BALLARD, MELODY
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:BALLARD
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 1:2200 BENJAMIN FRANKLIN PKWY APT E1114
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-3761
Mailing Address - Country:US
Mailing Address - Phone:267-901-5305
Mailing Address - Fax:215-561-4677
Practice Address - Street 1:6140 N 20TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19138-2419
Practice Address - Country:US
Practice Address - Phone:267-901-5305
Practice Address - Fax:215-561-4677
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-23
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care