Provider Demographics
NPI:1639143167
Name:HALL, AUDREY SADAR (MD)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:SADAR
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 1:2013 ROUTE 19
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:CRANBERRY TWP.
Mailing Address - State:PA
Mailing Address - Zip Code:16066
Mailing Address - Country:US
Mailing Address - Phone:724-779-3278
Mailing Address - Fax:
Practice Address - Street 1:2013 ROUTE 19
Practice Address - Street 2:SUITE 1000
Practice Address - City:CRANBERRY TWP.
Practice Address - State:PA
Practice Address - Zip Code:16066
Practice Address - Country:US
Practice Address - Phone:724-779-3278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044945L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001401710Medicaid
PA732216PD9Medicare ID - Type Unspecified
PA001401710Medicaid