Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | MD036517E | PA |
Y | 207QA0401X | Family Doctor - Addiction Medicine | MD036517E | PA |
NPI | 1780688366 |
---|---|
Provider Name | Dr. Michael M Hall |
First Address | Du Bois, PA 15801-1440 |
Second Address | Du Bois, PA 15801-1463 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2005 |
Last Update Date | 13/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001132739 | (05) | PA |
591707Q09 | MC PTAN (01) | PA |
852695FFU | MC PTAN (01) | PA |
C34727 | (02) | PA |