MEDICARE: MANDA L HALL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician	M9724	TX

General Provider Information

NPI Number	:	1417976788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANDA L HALL M.D.

Provider Business Mailing Address
First Line	:	17064 CONWAY SPRINGS CT
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78717-2989
Country	:	US
Telephone Number	:	512-426-4846
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 W 49TH ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78756-3101
Country	:	US
Telephone Number	:	512-776-7321
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	01/13/2021

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Directions to “ MANDA L HALL M.D.” Practice Location

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