Provider Demographics
NPI:1881676484
Name:HALL, MARSHALL CRAIG (MD)
Entity Type:Individual
Prefix:
First Name:MARSHALL
Middle Name:CRAIG
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 1:1100 KENSINGTON DR
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-4503
Mailing Address - Country:US
Mailing Address - Phone:336-978-8422
Mailing Address - Fax:
Practice Address - Street 1:3 GLEN COVE DR STE 3
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-4232
Practice Address - Country:US
Practice Address - Phone:207-301-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD25171208800000X
NC9801292208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891161FMedicaid
NCP00325648OtherRAILROAD MEDICARE
2263067CMedicare PIN
NC891161FMedicaid
NC2263067BMedicare PIN
NC2263067BMedicare PIN