Provider Demographics
NPI:1093827701
Name:OAKLAND COMMONS FAMILY PRACTICE
Entity Type:Organization
Organization Name:OAKLAND COMMONS FAMILY PRACTICE
Other - Org Name:DR DAVID HALL, MD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LESLIE
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-594-0765
Mailing Address - Street 1:825 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-4243
Mailing Address - Country:US
Mailing Address - Phone:207-594-0765
Mailing Address - Fax:207-596-7507
Practice Address - Street 1:825 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-4243
Practice Address - Country:US
Practice Address - Phone:207-594-0765
Practice Address - Fax:207-596-7507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME017061302R00000X
ME010248302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization