Healthcare Provider Details

I. General information

NPI: 1396858767
Provider Name (Legal Business Name): MELINDA SUE HALL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 04/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 OLD COURTHOUSE RD SUITE 140B
VIENNA VA
22182-3822
US

IV. Provider business mailing address

8300 OLD COURTHOUSE RD SUITE 140B
VIENNA VA
22182-3822
US

V. Phone/Fax

Practice location:
  • Phone: 703-991-6806
  • Fax: 703-854-1180
Mailing address:
  • Phone: 703-226-4012
  • Fax: 703-226-4010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number0101035022
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: