Healthcare Provider Details

I. General information

NPI: 1902565658
Provider Name (Legal Business Name): BRIANNA HALL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRIANNA GRONINGER

II. Dates (important events)

Enumeration Date: 12/09/2021
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3551 N BROAD ST
PHILADELPHIA PA
19140-4160
US

IV. Provider business mailing address

3551 N BROAD ST
PHILADELPHIA PA
19140-4160
US

V. Phone/Fax

Practice location:
  • Phone: 215-430-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA062681
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: