Healthcare Provider Details

I. General information

NPI: 1710182407
Provider Name (Legal Business Name): ANDREW M HALL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 PECAN ST SE
WASHINGTON DC
20032-2652
US

IV. Provider business mailing address

3811 FAIRFAX DR STE 1000
ARLINGTON VA
22203-1782
US

V. Phone/Fax

Practice location:
  • Phone: 771-444-6200
  • Fax:
Mailing address:
  • Phone: 202-741-3570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number111866
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD600004378
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: