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Individual
SMITHA M BALLYAMANDA
Active
Individual
SMITHA M BALLYAMANDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
2016-02043
NC
207Q00000X
Family Medicine Physician
Primary
36544
SC
207QS0010X
Sports Medicine (Family Medicine) Physician
2016-02043
NC
207QS0010X
Sports Medicine (Family Medicine) Physician
36544
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
365447
—
SC
Enumeration date
06/22/2009
Last updated
06/05/2017
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