Provider Demographics
NPI:1326050428
Name:HALL, GREGORY D (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:D
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 1:2323 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-1332
Mailing Address - Country:US
Mailing Address - Phone:302-656-1616
Mailing Address - Fax:302-656-7698
Practice Address - Street 1:2323 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-1332
Practice Address - Country:US
Practice Address - Phone:302-656-1616
Practice Address - Fax:302-656-7698
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10001663207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE031027Medicare PIN
DEDO1052Medicare UPIN