Provider Demographics
NPI:1497747760
Name:HALL, SHELLY M (MD)
Entity Type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:M
Last Name:HALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5454 WISCONSIN AVE
Mailing Address - Street 2:SUITE 825
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-6901
Mailing Address - Country:US
Mailing Address - Phone:301-652-0644
Mailing Address - Fax:301-652-8722
Practice Address - Street 1:5454 WISCONSIN AVE
Practice Address - Street 2:SUITE 825
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-6901
Practice Address - Country:US
Practice Address - Phone:301-652-0644
Practice Address - Fax:301-652-8722
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0063933207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA07BBSKKMedicare ID - Type Unspecified
GAG34188Medicare UPIN