Provider Demographics
NPI:1801971593
Name:HALL, LEILA TUCKER (MD)
Entity type:Individual
Prefix:
First Name:LEILA
Middle Name:TUCKER
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 1:18506 OFFICE PARK DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-0585
Mailing Address - Country:US
Mailing Address - Phone:301-840-0840
Mailing Address - Fax:
Practice Address - Street 1:18506 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY VILLAGE
Practice Address - State:MD
Practice Address - Zip Code:20886-0585
Practice Address - Country:US
Practice Address - Phone:301-840-0840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2011-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD035161208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC036478700Medicaid
MD408578700Medicaid
VA10129354Medicaid
DC036478700Medicaid