Provider Demographics
NPI:1265566145
Name:HALL, ROGER CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:CHARLES
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 1:203 HANNAFORD HILL RD
Mailing Address - Street 2:
Mailing Address - City:VASSALBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04989-4217
Mailing Address - Country:US
Mailing Address - Phone:207-622-6193
Mailing Address - Fax:207-621-0602
Practice Address - Street 1:89 HOSPITAL ST
Practice Address - Street 2:SUITE 1
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-6651
Practice Address - Country:US
Practice Address - Phone:207-622-6193
Practice Address - Fax:207-621-0602
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME009795207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME127260000Medicaid
MEC66530Medicare UPIN
ME058245Medicare ID - Type UnspecifiedMEDICARE NUMBER