Provider Demographics
NPI:1336334895
Name:HALL, RICHARD CHALONER WINTON (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:CHALONER WINTON
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 1:2500 W LAKE MARY BLVD
Mailing Address - Street 2:SUITE 219
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3501
Mailing Address - Country:US
Mailing Address - Phone:407-322-8199
Mailing Address - Fax:407-322-8169
Practice Address - Street 1:2500 W LAKE MARY BLVD
Practice Address - Street 2:SUITE 219
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3501
Practice Address - Country:US
Practice Address - Phone:407-322-8199
Practice Address - Fax:407-322-8169
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-07
Last Update Date:2007-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00144702084F0202X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD55131Medicare UPIN