Provider Demographics
NPI:1265467856
Name:HALL, MADONNA J (DO)
Entity Type:Individual
Prefix:
First Name:MADONNA
Middle Name:J
Last Name:HALL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 N EAGLE CREEK DR
Mailing Address - Street 2:LCE-1
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1805
Mailing Address - Country:US
Mailing Address - Phone:859-258-5102
Mailing Address - Fax:859-258-5177
Practice Address - Street 1:100 N EAGLE CREEK DR
Practice Address - Street 2:LCE-1
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1805
Practice Address - Country:US
Practice Address - Phone:859-258-5102
Practice Address - Fax:859-258-5177
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY02477207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA080134442OtherRR MEDICARE PIN
KY37903705OtherMEDICAID LAB GRP
KY4000501OtherMEDICARE LAB GRP
GACB5773OtherRR MEDICARE GRP
KY64024771Medicaid
KY64024771Medicaid
KY37903705OtherMEDICAID LAB GRP
GA080134442OtherRR MEDICARE PIN
G31115Medicare UPIN