Healthcare Provider Details

I. General information

NPI: 1083852404
Provider Name (Legal Business Name): THOMAS M HALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2009
Last Update Date: 11/28/2020
Certification Date: 11/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 COLUMBIA RD NW COLUMBIA ROAD HEALTH CENTER
WASHINGTON DC
20009-3602
US

IV. Provider business mailing address

PO BOX 58206
WASHINGTON DC
20037-8206
US

V. Phone/Fax

Practice location:
  • Phone: 202-328-3717
  • Fax:
Mailing address:
  • Phone: 561-789-4492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberMD30764
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD30764
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: