Basic Information
| Provider Information | |||||||||
| NPI: | 1639150816 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JOHN W. HALL, MD, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1898 | ||||||||
| Address2: | |||||||||
| City: | WATERVILLE | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049031898 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078724400 | ||||||||
| FaxNumber: | 2078724621 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 CHASE AVE | ||||||||
| Address2: | |||||||||
| City: | WATERVILLE | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049014624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078724400 | ||||||||
| FaxNumber: | 2078724621 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HALL | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2078724400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.