Provider Demographics
NPI:1881313633
Name:HALL, VINCENT BERNARD
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:BERNARD
Last Name:HALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 CURTIS DR APT 102
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-2661
Mailing Address - Country:US
Mailing Address - Phone:301-267-9519
Mailing Address - Fax:
Practice Address - Street 1:3330 CURTIS DR APT 102
Practice Address - Street 2:
Practice Address - City:SUITLAND
Practice Address - State:MD
Practice Address - Zip Code:20746-2661
Practice Address - Country:US
Practice Address - Phone:301-267-9519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant