MEDICARE: MAUVERINE JO HALL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	036139295	IL
2	207Q00000X	Family Medicine Physician	24786	KY
3	207QA0505X	Adult Medicine Physician	94-00819	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609854124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAUVERINE JO HALL M.D.

Provider Business Mailing Address
First Line	:	284 BALMORAL STREET
Second Line	:
City	:	CLAYTON
State	:	NC
Zip	:	27520-4044
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3010 FALSTAFF RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-1813
Country	:	US
Telephone Number	:	919-212-9230
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	03/17/2018

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