Provider Demographics
NPI:1700028768
Name:HALL, CAMERON W (MD)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:W
Last Name:HALL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1415 PORTLAND AVE
Mailing Address - Street 2:SANDS CONSTELLATION HEART INSTITUTE
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-3038
Mailing Address - Country:US
Mailing Address - Phone:585-442-5320
Mailing Address - Fax:585-442-5526
Practice Address - Street 1:1415 PORTLAND AVE
Practice Address - Street 2:SANDS CONSTELLATION HEART INSTITUTE
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3038
Practice Address - Country:US
Practice Address - Phone:585-442-5320
Practice Address - Fax:585-442-5526
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2016-08-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY263346207RI0011X
NY263646207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03525308Medicaid
NYJ400308685Medicare PIN