1306090493 NPI number — MACY G. HALL, JR., MD., PA.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306090493 NPI number — MACY G. HALL, JR., MD., PA.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MACY G. HALL, JR., MD., PA.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1306090493
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16 GRANITE PL
Provider Second Line Business Mailing Address:
UNIT #180
Provider Business Mailing Address City Name:
GAITHERSBURG
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20878-6583
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-723-8768
Provider Business Mailing Address Fax Number:
202-520-8172

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16 GRANITE PL
Provider Second Line Business Practice Location Address:
UNIT #180
Provider Business Practice Location Address City Name:
GAITHERSBURG
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20878-6583
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-723-8768
Provider Business Practice Location Address Fax Number:
202-520-8172
Provider Enumeration Date:
11/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HALL
Authorized Official First Name:
MACY
Authorized Official Middle Name:
GIVINGS
Authorized Official Title or Position:
PLASTIC AND RECONSTRUCTIVE SURGERY
Authorized Official Telephone Number:
202-723-8768

Provider Taxonomy Codes

  • Taxonomy code: 208200000X , with the licence number:  MD25515 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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