Provider Demographics
NPI:1831310853
Name:HALL, ROBERT HARRY (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:HARRY
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 1:9619 WISSINOMING ST.
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114
Mailing Address - Country:US
Mailing Address - Phone:267-978-2119
Mailing Address - Fax:215-405-2108
Practice Address - Street 1:1225 VINE ST, THIRD FLOOR
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107
Practice Address - Country:US
Practice Address - Phone:215-405-2100
Practice Address - Fax:215-405-2108
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAM.D054344L2084P0804X
PAMD054344L2084P0800X, 2084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1501091Medicare ID - Type UnspecifiedPRIVATE PRACTICE