Provider Demographics
NPI:1033211065
Name:HALL, BURT WHITNEY (MD)
Entity Type:Individual
Prefix:DR
First Name:BURT
Middle Name:WHITNEY
Last Name:HALL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:65 WALNUT STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481
Mailing Address - Country:US
Mailing Address - Phone:781-237-3395
Mailing Address - Fax:781-237-3397
Practice Address - Street 1:65 WALNUT ST
Practice Address - Street 2:SUITE 590
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481
Practice Address - Country:US
Practice Address - Phone:781-237-3395
Practice Address - Fax:781-237-3397
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2015-10-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA37667207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB33488OtherBCBS
MAB37667OtherTUFTS
MAB37667OtherTUFTS
B72987Medicare UPIN