Provider Demographics
NPI:1134178353
Name:HALL, RICHARD A (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
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:PO BOX 1328
Mailing Address - Street 2:
Mailing Address - City:MT. STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353
Mailing Address - Country:US
Mailing Address - Phone:859-404-7686
Mailing Address - Fax:859-274-0785
Practice Address - Street 1:633 MAYSVILLE RD
Practice Address - Street 2:
Practice Address - City:MOUNT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-9767
Practice Address - Country:US
Practice Address - Phone:859-404-7686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY28173207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP40036028OtherMEDICARE
KY000000185160OtherANTHEM
KY64281736Medicaid
KY0169Medicare PIN
KYF05491Medicare UPIN
KY000000185160OtherANTHEM