Healthcare Provider Details

I. General information

NPI: 1467837245
Provider Name (Legal Business Name): ZAMYRA CHARDONNAY HALL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ZAMYRA C LAMBERT

II. Dates (important events)

Enumeration Date: 07/22/2015
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4470 REGENCY PL STE 106
WHITE PLAINS MD
20695-3085
US

IV. Provider business mailing address

5604 W DARROW DR
LAVEEN AZ
85339-2952
US

V. Phone/Fax

Practice location:
  • Phone: 240-252-2140
  • Fax: 240-252-2141
Mailing address:
  • Phone: 901-340-0669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number6107
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: