Marshall Ballou
Individual provider Active NPI Social Worker · Tamc, HI
NPI 1265459200 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1265459200
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- License
- 101333 (MA)
- Practice address
- 1 Jarrett White Rd
Tripler Army Medical Center
Tamc, HI 96859-5001 - Phone
- (808) 433-2998
- NPI assigned
- Jul 16, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 101333 | MA | MD | Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 101333 | MA | Yes |
Addresses
Primary practice location
1 Jarrett White Rd
Tripler Army Medical Center
Tamc, HI 96859-5001
Mailing address
PO Box 10886
Honolulu, HI 96816-0886
Phone (808) 433-2998
Other providers in Tamc, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.