Provider Demographics
NPI:1760819288
Name:HALL, ALLIE M (PA)
Entity Type:Individual
Prefix:
First Name:ALLIE
Middle Name:M
Last Name:HALL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ALLIE
Other - Middle Name:L
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:4900 COX RD
Mailing Address - Street 2:STE 150
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-6507
Mailing Address - Country:US
Mailing Address - Phone:804-346-1780
Mailing Address - Fax:804-346-1781
Practice Address - Street 1:4900 COX RD
Practice Address - Street 2:STE 150
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-6507
Practice Address - Country:US
Practice Address - Phone:804-346-1780
Practice Address - Fax:804-346-1781
Is Sole Proprietor?:No
Enumeration Date:2013-09-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1983363A00000X
VA0110004981363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP01302511OtherRR MEDICARE
SC1728PAMedicaid
SCSC19957819Medicare PIN
SCSC19957498Medicare PIN
SCSC19955282Medicare PIN
SCSC19955277Medicare PIN
SCSC19957499Medicare PIN
SCSC19957555Medicare PIN
SCSC19956882Medicare PIN
SCSC19955281Medicare PIN
SCSC19957126Medicare PIN
SC1728PAMedicaid
SCSC19956834Medicare PIN
SCP01302511OtherRR MEDICARE
SCSC19956868Medicare PIN
SCSC19957522Medicare PIN