Provider Demographics
NPI:1669821476
Name:HALL, SAMUEL GEORGE (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:GEORGE
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 1:425 WESTMINSTER AVE
Mailing Address - Street 2:SUITE A3
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-9141
Mailing Address - Country:US
Mailing Address - Phone:717-316-3481
Mailing Address - Fax:717-630-9228
Practice Address - Street 1:425 WESTMINSTER AVE
Practice Address - Street 2:SUITE A3
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-9141
Practice Address - Country:US
Practice Address - Phone:717-316-3481
Practice Address - Fax:717-630-9228
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMD467833207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program