Provider Demographics
NPI:1699024117
Name:HALL, KRISTAL (HAIR LOSS SPECIALIST)
Entity Type:Individual
Prefix:
First Name:KRISTAL
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4410 STAMP RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MARLOW HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-6700
Mailing Address - Country:US
Mailing Address - Phone:301-316-4526
Mailing Address - Fax:
Practice Address - Street 1:4410 STAMP RD STE 105
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-6700
Practice Address - Country:US
Practice Address - Phone:301-316-4526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD229202174400000X, 332B00000X
MD2292921744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
No174400000XOther Service ProvidersSpecialist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies