Provider Demographics
NPI:1073809547
Name:HALL, TANIA H (MD)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:H
Last Name:HALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:3260 PROVIDENCE DR
Mailing Address - Street 2:STE 322
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4661
Mailing Address - Country:US
Mailing Address - Phone:907-563-5151
Mailing Address - Fax:907-563-6278
Practice Address - Street 1:3260 PROVIDENCE DR
Practice Address - Street 2:STE 322
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4661
Practice Address - Country:US
Practice Address - Phone:907-563-5151
Practice Address - Fax:907-563-6278
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK100798207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1631642Medicaid