Provider Demographics
NPI:1902864432
Name:HALL, BLAINE PAXTON (PA-C)
Entity Type:Individual
Prefix:MR
First Name:BLAINE
Middle Name:PAXTON
Last Name:HALL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 SUGAR PINE DR
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-9307
Mailing Address - Country:US
Mailing Address - Phone:910-295-9561
Mailing Address - Fax:
Practice Address - Street 1:DUKE UNIVERSITY MEDICAL CENTER
Practice Address - Street 2:DUMC 3704
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-0001
Practice Address - Country:US
Practice Address - Phone:919-684-2705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0101453363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCR39791Medicare UPIN
NC2747644AMedicare PIN