Provider Demographics
NPI:1417973314
Name:HALL, ALYSON L (MD)
Entity Type:Individual
Prefix:
First Name:ALYSON
Middle Name:L
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 1:17001 SCIENCE DR STE 120
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-4330
Mailing Address - Country:US
Mailing Address - Phone:301-860-1090
Mailing Address - Fax:301-860-1095
Practice Address - Street 1:17001 SCIENCE DR
Practice Address - Street 2:SUITE 120
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-4329
Practice Address - Country:US
Practice Address - Phone:301-860-1090
Practice Address - Fax:301-860-1095
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0053812207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD859601800Medicaid
F82693Medicare UPIN
MD859601800Medicaid