1841402534 NPI number — HALL & HALL DERMATOLOGY ASSOCIATES PLLC

Table of content: (NPI 1841402534)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841402534 NPI number — HALL & HALL DERMATOLOGY ASSOCIATES PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HALL & HALL DERMATOLOGY ASSOCIATES PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HALL & HALL DERMATOLOY ASSOCIATES LP
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841402534
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 DRUMMOND STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORGANTOWN
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26505-3320
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-599-5672
Provider Business Mailing Address Fax Number:
304-599-5677

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 DRUMMOND STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORGANTOWN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26505-3320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-599-5672
Provider Business Practice Location Address Fax Number:
304-599-5677
Provider Enumeration Date:
05/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HALL
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
LLOYD
Authorized Official Title or Position:
PRACTICE MANAGER PARTNER
Authorized Official Telephone Number:
304-599-5672

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  20379 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207N00000X , with the licence number: 09283 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001712123 . This is a "BCBS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 2004674000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2004673000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000153677 . This is a "BC BS" identifier . This identifiers is of the category "OTHER".




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