Individual
HALLIE ANNE CAROL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3401 CIVIC CENTER BLVD, PHILADELPHIA, PA 19104-4319
(215) 590-7180
Mailing address
3401 CIVIC CENTER BLVD, PHILADELPHIA, PA 19104-4319
(215) 590-7180
Taxonomy
Speciality
Code
Description
License number
State
2080P0216X
Pediatric Rheumatology Physician
Primary
MT224869
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MD478487
MEDICAL PHYSICIAN AND SURGEON LISENCE
PA
01
—
MT224869
PENNSYLVANIA TRAINING LICENSE
PA
Enumeration date
03/18/2019
Last updated
06/24/2022
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