Provider Demographics
NPI:1275643686
Name:HALL, SANDRA (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7307
Mailing Address - Country:US
Mailing Address - Phone:910-341-3300
Mailing Address - Fax:910-251-8824
Practice Address - Street 1:1802 S 17TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6444
Practice Address - Country:US
Practice Address - Phone:910-343-1031
Practice Address - Fax:910-341-1050
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0301237207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC135Y7OtherBCBS NC
NC89135Y7Medicaid
NCP00397726OtherRAILROAD MEDICARE
NC2035918BMedicare PIN
NC135Y7OtherBCBS NC
NC2035918DMedicare PIN
NC89135Y7Medicaid