Provider Demographics
NPI:1184104481
Name:BALLARD, AZIA CIANI
Entity type:Individual
Prefix:MS
First Name:AZIA
Middle Name:CIANI
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 1:1358 LINDBERGH AVE
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-2313
Mailing Address - Country:US
Mailing Address - Phone:267-625-6708
Mailing Address - Fax:
Practice Address - Street 1:610 OLD YORK RD SUITE 400
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19001-1900
Practice Address - Country:US
Practice Address - Phone:484-680-1049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor