Provider Demographics
NPI:1235363490
Name:HALL, INGRID MARGOT (MD)
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:MARGOT
Last Name:HALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 WASHINGTON ST STE 2
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-4083
Mailing Address - Country:US
Mailing Address - Phone:315-755-3450
Mailing Address - Fax:315-755-3451
Practice Address - Street 1:629 WASHINGTON ST STE 2
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-4083
Practice Address - Country:US
Practice Address - Phone:315-755-3450
Practice Address - Fax:315-755-3451
Is Sole Proprietor?:No
Enumeration Date:2009-05-03
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.098517207R00000X
MI4301104645207RR0500X
390200000X
NY303908207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0A37669Medicare PIN