Provider Demographics
NPI:1790300903
Name:HALL DIABETES MANAGEMENT AND RESOURCE CENTER PC
Entity Type:Organization
Organization Name:HALL DIABETES MANAGEMENT AND RESOURCE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:ANP-BC
Authorized Official - Phone:443-676-5422
Mailing Address - Street 1:1900 E NORTHERN PKWY STE T1
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-2120
Mailing Address - Country:US
Mailing Address - Phone:443-676-5422
Mailing Address - Fax:
Practice Address - Street 1:1900 E NORTHERN PKWY STE T1
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-2120
Practice Address - Country:US
Practice Address - Phone:443-676-5422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-12
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty