Provider Demographics
NPI:1073376182
Name:HALL, DEVON M
Entity Type:Individual
Prefix:
First Name:DEVON
Middle Name:M
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6107 WELSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-3838
Mailing Address - Country:US
Mailing Address - Phone:202-717-7649
Mailing Address - Fax:
Practice Address - Street 1:3605 MINNESODA AVE.
Practice Address - Street 2:
Practice Address - City:SOUTHEST
Practice Address - State:DC
Practice Address - Zip Code:20019
Practice Address - Country:US
Practice Address - Phone:202-717-7649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider