Provider Demographics
NPI:1679058911
Name:MARTIN-HALL, PETREL (NP)
Entity type:Individual
Prefix:MRS
First Name:PETREL
Middle Name:
Last Name:MARTIN-HALL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 PINE HEIGHTS AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-5285
Mailing Address - Country:US
Mailing Address - Phone:667-802-2100
Mailing Address - Fax:240-215-1140
Practice Address - Street 1:1001 PINE HEIGHTS AVE STE 304
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-5285
Practice Address - Country:US
Practice Address - Phone:667-802-2100
Practice Address - Fax:240-215-1140
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR211887363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD222826500Medicaid