Provider Demographics
NPI:1669460374
Name:HALL, DANIEL CRAWFORD (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:CRAWFORD
Last Name:HALL
Suffix:
Gender:M
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:844-266-8268
Mailing Address - Fax:
Practice Address - Street 1:5145 SELLERS RD
Practice Address - Street 2:
Practice Address - City:SHALLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28470
Practice Address - Country:US
Practice Address - Phone:910-754-4441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20910207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
24827OtherMEDCOST
SCN20910Medicaid
FH1000140OtherFIRST CAROLINA CARE
NC8938226Medicaid
7990526OtherAETNA
1808198001OtherCIGNA PAL
NC38226OtherBCBS
NC20910OtherSTATE LICENSE
NC080145043 RAILROADMedicare PIN
NCC84274Medicare UPIN
NC206934DMedicare PIN