Provider Demographics
NPI:1730169814
Name:HALL, SUZANNE ELLEN (MD)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:ELLEN
Last Name:HALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 S NAPLES RD UNIT 694
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:NC
Mailing Address - Zip Code:28760-9700
Mailing Address - Country:US
Mailing Address - Phone:828-697-1944
Mailing Address - Fax:828-697-3661
Practice Address - Street 1:121 S NAPLES RD UNIT 694
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:NC
Practice Address - Zip Code:28760-9700
Practice Address - Country:US
Practice Address - Phone:828-697-1944
Practice Address - Fax:828-697-3661
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2004 00040207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902294Medicaid
NC5902294Medicaid
NC2047852Medicare ID - Type Unspecified