Provider Demographics
NPI:1083622674
Name:HALL, EDWARD BROOKS (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:BROOKS
Last Name:HALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:294 DANIEL WEBSTER HWY
Mailing Address - Street 2:
Mailing Address - City:MERRIMACK
Mailing Address - State:NH
Mailing Address - Zip Code:03054-4474
Mailing Address - Country:US
Mailing Address - Phone:603-424-4713
Mailing Address - Fax:
Practice Address - Street 1:294 DANIEL WEBSTER HWY
Practice Address - Street 2:
Practice Address - City:MERRIMACK
Practice Address - State:NH
Practice Address - Zip Code:03054-4474
Practice Address - Country:US
Practice Address - Phone:603-424-4713
Practice Address - Fax:603-424-2915
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6559207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH85Medicaid
NHE16692Medicare UPIN
NH85Medicaid