Healthcare Provider Details

I. General information

NPI: 1396002606
Provider Name (Legal Business Name): MICHAEL HALL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2012
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 ARK RD STE 102
MOUNT LAUREL NJ
08054-3100
US

IV. Provider business mailing address

1020 KINGS HWY N STE 201
CHERRY HILL NJ
08034-1906
US

V. Phone/Fax

Practice location:
  • Phone: 856-602-4000
  • Fax: 856-946-1747
Mailing address:
  • Phone: 856-602-4000
  • Fax: 856-842-5109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberQ9821
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: