Provider Demographics
NPI:1245237932
Name:HALL, SHERRY LENE (MD)
Entity type:Individual
Prefix:DR
First Name:SHERRY
Middle Name:LENE
Last Name:HALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202-A BEECHMONT ROAD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-2547
Mailing Address - Country:US
Mailing Address - Phone:434-575-6300
Mailing Address - Fax:434-575-8300
Practice Address - Street 1:2202-A BEECHMONT ROAD
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-2547
Practice Address - Country:US
Practice Address - Phone:434-575-6300
Practice Address - Fax:434-575-8300
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101041465207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005880777Medicaid
236436OtherBCBS
VA005880777Medicaid
00V010S77Medicare PIN