Provider Demographics
NPI:1376996892
Name:HALL, DEVIN NICOLE (MD)
Entity Type:Individual
Prefix:
First Name:DEVIN
Middle Name:NICOLE
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 1:710 WEST 168TH ST, 3RD FLOOR
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032
Mailing Address - Country:US
Mailing Address - Phone:212-305-3829
Mailing Address - Fax:212-305-1304
Practice Address - Street 1:710 WEST 168TH ST, 3RD FLOOR
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032
Practice Address - Country:US
Practice Address - Phone:212-305-1303
Practice Address - Fax:212-305-1304
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2017-03-23
Deactivation Date:2017-02-28
Deactivation Code:
Reactivation Date:2017-03-21
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program