Provider Demographics
NPI:1740214287
Name:HALL, WALTER ALLAN (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:ALLAN
Last Name:HALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 IRVING AVE
Mailing Address - Street 2:STE. 503
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1603
Mailing Address - Country:US
Mailing Address - Phone:315-464-4470
Mailing Address - Fax:315-464-5520
Practice Address - Street 1:725 IRVING AVE
Practice Address - Street 2:STE. 503
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1603
Practice Address - Country:US
Practice Address - Phone:315-464-4470
Practice Address - Fax:315-464-5520
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN33774207T00000X
NY243228207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0051255Medicaid
MN2T377HAOtherBCBS
MN686499OtherARAZ
MN06-22493OtherMEDICA CHOICE
MN1009129OtherPREFERRED ONE
MN140001545OtherRAIL ROAD MEDICARE
MN246205200Medicaid
WI31665700Medicaid
IA0506824Medicaid
SD7777470Medicaid
MN101270OtherUCARE
MNHP16338OtherHEALTHPARTNERS
ND10387Medicaid
NY02856706Medicaid
MN06-74537OtherMEDICA PRIMARY
MN140001545OtherRAIL ROAD MEDICARE
MN2T377HAOtherBCBS
NYRB4022Medicare PIN