Provider Demographics
NPI:1659357689
Name:HALLE, DAVID A (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:HALLE
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 1:143 LONGWATER DR
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1683
Mailing Address - Country:US
Mailing Address - Phone:781-878-5200
Mailing Address - Fax:
Practice Address - Street 1:143 LONGWATER DR
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1683
Practice Address - Country:US
Practice Address - Phone:781-878-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA157205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
042297845OtherGREAT WEST
1659357689OtherNHP
MA3184200Medicaid
042297845OtherTRICARE
042297845OtherMULTI-PLAN
7741098OtherAETNA
J19507OtherBCBSMA
042297845OtherHCVM
794601OtherTUFTS AND TUFTS MEDICARE PREFERRED
042297845OtherGIC/UNICARE
1659357689OtherFALLON
AA188364OtherHARVARD PILGRIM
9728913OtherCIGNA
7741098OtherAETNA
MAG78011Medicare UPIN
MA3184200Medicaid