MEDICARE: LEAH BETH HALL PA

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	363AS0400X	Surgical Physician Assistant	1000313	NC
2	363A00000X	Physician Assistant	0010-00313	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	:	1770555195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH BETH HALL PA

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:	704-384-9113
Fax Number	:	704-316-0508

Provider Business Practice Location Address
First Line	:	125 QUEENS RD STE 250
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-3419
Country	:	US
Telephone Number	:	704-316-5100
Fax Number	:	704-316-5101

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

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	06/26/2023

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Directions to “ LEAH BETH HALL PA” Practice Location

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