Provider Demographics
NPI:1669400206
Name:HALL, TIMOTHY J (PA)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:J
Last Name:HALL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 EVERETT RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-1427
Mailing Address - Country:US
Mailing Address - Phone:518-463-0171
Mailing Address - Fax:578-463-0174
Practice Address - Street 1:3 CARE LANE
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12211
Practice Address - Country:US
Practice Address - Phone:518-682-2240
Practice Address - Fax:518-682-2243
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0012381363AS0400X
NY001238363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBB5206Medicare ID - Type Unspecified
NYBB5206Medicare UPIN