Provider Demographics
NPI:1881636686
Name:HALL, BURR W (MD)
Entity Type:Individual
Prefix:
First Name:BURR
Middle Name:W
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 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 679B
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-2475
Mailing Address - Fax:585-473-0477
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-275-4775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231681207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02529197Medicaid
NYP020231681OtherBLUE SHIELD
NY142527BOOtherPREFERRED CARE
NYP00165447OtherMEDICARE RAILROAD
NY000925113001OtherBC/BS OF WESTERN NY
NYP010231681OtherBLUE CHOICE
NY2198369OtherINDEPENDENT HEALTH
NY7291585OtherAETNA
NYRA2560Medicare ID - Type Unspecified
NYP010231681OtherBLUE CHOICE