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General NPI Number Information
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NPI Number | 1548530827
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Entity Type | Individual
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Provider Name | NICHOLAS ROBERT HALL PA
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Gender | Male
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Dates
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Enumeration Date | 01/04/2012
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Last Update Date | 01/04/2012
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Provider Practice Location Address
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Address Line | 2210 WILBORN AVE
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City | SOUTH BOSTON
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State | VA
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Zip | 24592-1630
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Country | US
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Telephone | 434-575-5864
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Fax |
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Provider Business Mailing Address
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Address Line | 9400 WEATHERSFIELD DR
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City | BRISTOW
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State | VA
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Zip | 20136-1716
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Country | US
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Telephone | 703-973-2240
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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