Provider Demographics
NPI:1245298553
Name:HALL, DANA P (MD)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:P
Last Name:HALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:300 JEFFERSON BLVD
Mailing Address - Street 2:SUITE# 305
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888-3888
Mailing Address - Country:US
Mailing Address - Phone:401-739-7546
Mailing Address - Fax:401-739-7544
Practice Address - Street 1:300 JEFFERSON BLVD
Practice Address - Street 2:SUITE# 305
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-3888
Practice Address - Country:US
Practice Address - Phone:401-739-7546
Practice Address - Fax:401-739-7544
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RI11167207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI007057497OtherPTAN
RI9024192Medicaid
RI079024192OtherMEDICARE PTAN- INDIVIDUAL
RI079024192OtherMEDICARE PTAN- INDIVIDUAL
RI007057497OtherPTAN