Provider Demographics
NPI:1417954009
Name:HALE, JOHN ERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ERIC
Last Name:HALE
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:PO BOX 786
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-0786
Mailing Address - Country:US
Mailing Address - Phone:302-645-2281
Mailing Address - Fax:
Practice Address - Street 1:1305 SAVANNAH RD
Practice Address - Street 2:SUITE 1
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-1514
Practice Address - Country:US
Practice Address - Phone:302-645-2281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0003667207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001OtherCAREFIRST BCBS DC
DE52353201OtherCAREFIRST BCBS MD
DE828139OtherMAMSI
DE0510681000OtherAMERIHEALTH
DE0000319901Medicaid
DE080067313OtherRAILROAD MEDICARE
DE1419775OtherCIGNA
DE15RE30OtherBCBS DE
DE4370859OtherAETNA
DE0000319901Medicaid
DE516519Medicare PIN
DE828139OtherMAMSI