Provider Demographics
NPI:1861901738
Name:HUGHES HALLETT, NICOLA (PA-C)
Entity type:Individual
Prefix:
First Name:NICOLA
Middle Name:
Last Name:HUGHES HALLETT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9910 FRANKLIN SQUARE DR STE 2110
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4902
Mailing Address - Country:US
Mailing Address - Phone:410-933-6423
Mailing Address - Fax:
Practice Address - Street 1:401 NORTH BROADWAY
Practice Address - Street 2:WEINBERG ROOM 5C
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21231
Practice Address - Country:US
Practice Address - Phone:410-955-8985
Practice Address - Fax:410-614-4501
Is Sole Proprietor?:No
Enumeration Date:2017-09-23
Last Update Date:2019-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC06924363A00000X
VA0110005914363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical