Healthcare Provider Details

I. General information

NPI: 1386664639
Provider Name (Legal Business Name): DENNIS M HALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 12/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 BESTGATE ROAD STE 215
ANNAPOLIS MD
21401
US

IV. Provider business mailing address

10000 BAY PINES BLVD
BAY PINES FL
33744-8200
US

V. Phone/Fax

Practice location:
  • Phone: 410-573-9805
  • Fax: 410-573-9806
Mailing address:
  • Phone: 727-398-6661
  • Fax: 727-319-1184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberD0041216
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD16322
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101042749
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: