Healthcare Provider Details

I. General information

NPI: 1689898066
Provider Name (Legal Business Name): NADIM LOUIS HALLAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7811 MONTROSE RD STE 340
POTOMAC MD
20854-3359
US

IV. Provider business mailing address

7811 MONTROSE RD STE 340
POTOMAC MD
20854-3359
US

V. Phone/Fax

Practice location:
  • Phone: 301-588-7888
  • Fax:
Mailing address:
  • Phone: 301-588-7888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberD74147
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberD74147
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: