Basic Information
| Provider Information | |||||||||
| NPI: | 1225780349 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HALL | ||||||||
| FirstName: | AMBER | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 631280 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452631280 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108647376 | ||||||||
| FaxNumber: | 8775993340 | ||||||||
| Practice Location | |||||||||
| Address1: | 606 E BALTIMORE PIKE FL 2 | ||||||||
| Address2: | |||||||||
| City: | MEDIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190631751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108647376 | ||||||||
| FaxNumber: | 8775993340 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2022 | ||||||||
| LastUpdateDate: | 01/20/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | RBT-22-199123 | PA | Y |
No ID Information.