Provider Demographics
NPI:1114091287
Name:HALL, WILLIAM LLOYD (MEDICAL DOCTOR)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:LLOYD
Last Name:HALL
Suffix:
Gender:M
Credentials:MEDICAL DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 DRUMMOND STREET
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-3320
Mailing Address - Country:US
Mailing Address - Phone:304-599-5672
Mailing Address - Fax:304-599-5677
Practice Address - Street 1:400 DRUMMOND STREET
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3320
Practice Address - Country:US
Practice Address - Phone:304-599-5672
Practice Address - Fax:304-599-5677
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV09283207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2004674000Medicaid
000153677OtherBCBS
A71918Medicare UPIN
WV2004674000Medicaid