Provider Demographics
NPI:1083725204
Name:HALL, MARY ALICE (MD)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ALICE
Last Name:HALL
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 277
Mailing Address - Street 2:
Mailing Address - City:MC DOWELL
Mailing Address - State:KY
Mailing Address - Zip Code:41647-0277
Mailing Address - Country:US
Mailing Address - Phone:606-377-2492
Mailing Address - Fax:606-377-1018
Practice Address - Street 1:9788 KY RT 122
Practice Address - Street 2:STE 2
Practice Address - City:MC DOWELL
Practice Address - State:KY
Practice Address - Zip Code:41647-6042
Practice Address - Country:US
Practice Address - Phone:606-377-2492
Practice Address - Fax:606-377-1018
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-10-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY13655207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
020364400OtherFEDERAL BLACK LUNG/DOL
KY64136559Medicaid
0303224OtherUMWA
230264400OtherDEPT OF LABOR/ACS UNIT/WO
000000048789OtherANTHEM BLUE CROSS/SHIELD
011769726OtherPALMETTO RAILROAD MEDICAR
0303224OtherUMWA
000000048789OtherANTHEM BLUE CROSS/SHIELD