=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386664639
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DENNIS M HALL MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2006
-----------------------------------------------------
Last Update Date | 12/16/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 888 BESTGATE ROAD STE 215
-----------------------------------------------------
City | ANNAPOLIS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-573-9805
-----------------------------------------------------
Fax | 410-573-9806
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10000 BAY PINES BLVD
-----------------------------------------------------
City | BAY PINES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33744-8200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-398-6661
-----------------------------------------------------
Fax | 727-319-1184
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | D0041216
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | MD16322
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 0101042749
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------