MEDICARE: MYRA JANE 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	170100000X	Ph.D. Medical Genetics	36463	NC
2	207Q00000X	Family Medicine Physician	22874	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	:	1811991342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYRA JANE HALL M.D.

Provider Business Mailing Address
First Line	:	210 MAGNOLIA SQUARE COURT
Second Line	:
City	:	ABERDEEN
State	:	NC
Zip	:	28315-2226
Country	:	US
Telephone Number	:	910-944-0779
Fax Number	:	910-944-2298

Provider Business Practice Location Address
First Line	:	210 MAGNOLIA SQUARE COURT
Second Line	:
City	:	ABERDEEN
State	:	NC
Zip	:	28315-2226
Country	:	US
Telephone Number	:	910-944-0779
Fax Number	:	910-944-2298

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	05/04/2011

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