Provider Demographics
NPI:1396858767
Name:HALL, MELINDA SUE (MD)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:SUE
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 1:8300 OLD COURTHOUSE RD
Mailing Address - Street 2:SUITE 140B
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3822
Mailing Address - Country:US
Mailing Address - Phone:703-226-4012
Mailing Address - Fax:703-226-4010
Practice Address - Street 1:8300 OLD COURTHOUSE RD
Practice Address - Street 2:SUITE 140B
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3822
Practice Address - Country:US
Practice Address - Phone:703-991-6806
Practice Address - Fax:703-854-1180
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101035022207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2730784OtherCIGNA
DCN036-0001OtherCAREFIRST NAT'L CAPITAL A
VA189115OtherANTHEM
2145117OtherMAMSI
C89191Medicare UPIN
VA189115OtherANTHEM
2145117OtherMAMSI
DCN036-0001OtherCAREFIRST NAT'L CAPITAL A