Provider Demographics
NPI:1255524401
Name:HALL, DALTON MONZELLROE JR (SA-C)
Entity type:Individual
Prefix:MR
First Name:DALTON
Middle Name:MONZELLROE
Last Name:HALL
Suffix:JR
Gender:M
Credentials:SA-C
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Mailing Address - Street 1:1011 HAWKINS WAY
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5179
Mailing Address - Country:US
Mailing Address - Phone:703-798-5924
Mailing Address - Fax:
Practice Address - Street 1:1011 HAWKINS WAY
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5179
Practice Address - Country:US
Practice Address - Phone:703-798-5924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2019-01-22
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical