Healthcare Provider Details

I. General information

NPI: 1710962220
Provider Name (Legal Business Name): MATTHEW D HALL MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 WILSON BLVD SUITE 1100
ARLINGTON VA
22203-1800
US

IV. Provider business mailing address

3903 PENSHURST LN APT # 304
WOODBRIDGE VA
22192-6330
US

V. Phone/Fax

Practice location:
  • Phone: 202-493-1226
  • Fax: 202-493-1739
Mailing address:
  • Phone: 703-670-3784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberMD042500-E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: