Provider Demographics
NPI:1306090493
Name:MACY G. HALL, JR., MD., PA.
Entity type:Organization
Organization Name:MACY G. HALL, JR., MD., PA.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PLASTIC AND RECONSTRUCTIVE SURGERY
Authorized Official - Prefix:DR
Authorized Official - First Name:MACY
Authorized Official - Middle Name:GIVINGS
Authorized Official - Last Name:HALL
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:202-723-8768
Mailing Address - Street 1:16 GRANITE PL
Mailing Address - Street 2:UNIT #180
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-6583
Mailing Address - Country:US
Mailing Address - Phone:202-723-8768
Mailing Address - Fax:202-520-8172
Practice Address - Street 1:16 GRANITE PL
Practice Address - Street 2:UNIT #180
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-6583
Practice Address - Country:US
Practice Address - Phone:202-723-8768
Practice Address - Fax:202-520-8172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD25515208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCC88329Medicare UPIN