Healthcare Provider Details

I. General information

NPI: 1104488188
Provider Name (Legal Business Name): BIANCA ELENA HALL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MANNING DR
CHAPEL HILL NC
27514-4220
US

IV. Provider business mailing address

3 COOPER PLZ RM 221
CAMDEN NJ
08103-1438
US

V. Phone/Fax

Practice location:
  • Phone: 984-974-1000
  • Fax:
Mailing address:
  • Phone: 856-342-2000
  • Fax: 856-365-1967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberP18-00385
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: