Provider Demographics
NPI:1588664635
Name:HALL, WILLIAM C (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:C
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 1:546 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-6600
Mailing Address - Country:US
Mailing Address - Phone:203-235-2511
Mailing Address - Fax:203-639-0809
Practice Address - Street 1:546 S BROAD ST
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-6600
Practice Address - Country:US
Practice Address - Phone:203-235-2511
Practice Address - Fax:203-639-0809
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT020500207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0R0102OtherHEALTHNET
CTNHS395OtherOXFORD
CT4111884OtherAETNA
CT730028OtherCONNECTICARE
CT180021469OtherRAILROAD MEDICARE
CT001205004Medicaid
CT180008283OtherRAILROAD MEDICARE
CT010020500CT01OtherANTHEM
CT0R0102OtherHEALTHNET
CT001205004Medicaid