Provider Demographics
NPI:1629123096
Name:HALLY, ROBERT J (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:HALLY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:224 D CORNWALL STREET NW
Mailing Address - Street 2:STE 403
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-2704
Mailing Address - Country:US
Mailing Address - Phone:703-737-6010
Mailing Address - Fax:703-443-8643
Practice Address - Street 1:4660 KENMORE AVENUE, SUITE 305
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-1306
Practice Address - Country:US
Practice Address - Phone:703-751-5763
Practice Address - Fax:703-370-8704
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2024-03-19
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Provider Licenses
StateLicense IDTaxonomies
VA0101230442207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCP00759582OtherRR MEDICARE
VA1629123096Medicaid
VA30015891610001Medicaid
VAF61647Medicare UPIN