1013381839 NPI number — COREY ANDREW HALL PT, DPT

Table of content: (NPI 1942917547)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013381839 NPI number — COREY ANDREW HALL PT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALL
Provider First Name:
COREY
Provider Middle Name:
ANDREW
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013381839
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
12/30/2023
NPI Reactivation Date:
01/09/2024

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1636 ABERDEEN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOWSON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21286-8124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-564-6085
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 W 41ST ST STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21211-1504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-357-1529
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/17/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  25763 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 462714ZAVL . This is a "MEDICARE PTAN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 025024 . This is a "OPTUM" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: T208 0127 . This is a "CAREFIRST" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 9561034 . This is a "CIGNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1024591 00 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 310275 . This is a "JHHC" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




Copyright © 2007-2026 www.npivalidator.com