Provider Demographics
NPI:1780645572
Name:HALL, ANDRE FELTON (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:FELTON
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 1:3601 CAPE CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4457
Mailing Address - Country:US
Mailing Address - Phone:910-484-3101
Mailing Address - Fax:910-484-7133
Practice Address - Street 1:3601 CAPE CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4457
Practice Address - Country:US
Practice Address - Phone:910-484-3101
Practice Address - Fax:910-484-7133
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600195207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8938291Medicaid
G27633Medicare UPIN
NC8938291Medicaid