Provider Demographics
NPI:1326091992
Name:HALL, LANNIECE F (MD)
Entity Type:Individual
Prefix:DR
First Name:LANNIECE
Middle Name:F
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 1:623 W UNION BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-3708
Mailing Address - Country:US
Mailing Address - Phone:610-868-0104
Mailing Address - Fax:610-868-0204
Practice Address - Street 1:623 W UNION BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-3708
Practice Address - Country:US
Practice Address - Phone:610-868-0104
Practice Address - Fax:610-868-0204
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08051900207V00000X
PAMD443998207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0106135Medicaid
NJI70994Medicare UPIN
NJ107714Medicare PIN