Basic Information
Provider Information
NPI: 1477637528
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HALL
FirstName: WILLIAM
MiddleName: LEE
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1121 SITUS CT STE 170
Address2:  
City: RALEIGH
State: NC
PostalCode: 276064279
CountryCode: US
TelephoneNumber: 9198342767
FaxNumber: 9198514660
Practice Location
Address1: 3643 N ROXBORO ST
Address2:  
City: DURHAM
State: NC
PostalCode: 277042702
CountryCode: US
TelephoneNumber: 9194705277
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/25/2006
LastUpdateDate: 11/20/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0202X2000-00443NCY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

No ID Information.


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