Provider Demographics
NPI:1679144869
Name:HALL, JENNIFER IRENE (LMT, BCBTMB)
Entity type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:IRENE
Last Name:HALL
Suffix:
Gender:F
Credentials:LMT, BCBTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2417 SILVERSIDE RD STE 4
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-4531
Mailing Address - Country:US
Mailing Address - Phone:302-463-6043
Mailing Address - Fax:
Practice Address - Street 1:2417 SILVERSIDE RD STE 4
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4531
Practice Address - Country:US
Practice Address - Phone:302-463-6043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE00039512083B0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE