Basic Information
| Provider Information | |||||||||
| NPI: | 1740214287 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HALL | ||||||||
| FirstName: | WALTER | ||||||||
| MiddleName: | ALLAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 725 IRVING AVE | ||||||||
| Address2: | STE. 503 | ||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132101603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154644470 | ||||||||
| FaxNumber: | 3154645520 | ||||||||
| Practice Location | |||||||||
| Address1: | 725 IRVING AVE | ||||||||
| Address2: | STE. 503 | ||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132101603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154644470 | ||||||||
| FaxNumber: | 3154645520 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 10/17/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 33774 | MN | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | 243228 | NY | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0051255 | 05 | MT | MEDICAID | 2T377HA | 01 | MN | BCBS | OTHER | 686499 | 01 | MN | ARAZ | OTHER | 06-22493 | 01 | MN | MEDICA CHOICE | OTHER | 1009129 | 01 | MN | PREFERRED ONE | OTHER | 140001545 | 01 | MN | RAIL ROAD MEDICARE | OTHER | 246205200 | 05 | MN | MEDICAID | 31665700 | 05 | WI | MEDICAID | 0506824 | 05 | IA | MEDICAID | 7777470 | 05 | SD | MEDICAID | 101270 | 01 | MN | UCARE | OTHER | HP16338 | 01 | MN | HEALTHPARTNERS | OTHER | 10387 | 05 | ND | MEDICAID | 02856706 | 05 | NY | MEDICAID | 06-74537 | 01 | MN | MEDICA PRIMARY | OTHER |