1396858767 NPI number — MELINDA SUE HALL MD

Table of content: MELINDA SUE HALL MD (NPI 1396858767)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396858767 NPI number — MELINDA SUE HALL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALL
Provider First Name:
MELINDA
Provider Middle Name:
SUE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1396858767
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8300 OLD COURTHOUSE RD
Provider Second Line Business Mailing Address:
SUITE 140B
Provider Business Mailing Address City Name:
VIENNA
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22182-3822
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-226-4012
Provider Business Mailing Address Fax Number:
703-226-4010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8300 OLD COURTHOUSE RD
Provider Second Line Business Practice Location Address:
SUITE 140B
Provider Business Practice Location Address City Name:
VIENNA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22182-3822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-991-6806
Provider Business Practice Location Address Fax Number:
703-854-1180
Provider Enumeration Date:
08/17/2006

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: 207VG0400X , with the licence number:  0101035022 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2730784 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: N036-0001 . This is a "CAREFIRST NAT'L CAPITAL A" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 189115 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2145117 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".




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