Provider Demographics
NPI:1841402534
Name:HALL & HALL DERMATOLOGY ASSOCIATES PLLC
Entity type:Organization
Organization Name:HALL & HALL DERMATOLOGY ASSOCIATES PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-599-5672
Mailing Address - Street 1:400 DRUMMOND STREET
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-3320
Mailing Address - Country:US
Mailing Address - Phone:304-599-5672
Mailing Address - Fax:304-599-5677
Practice Address - Street 1:400 DRUMMOND STREET
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3320
Practice Address - Country:US
Practice Address - Phone:304-599-5672
Practice Address - Fax:304-599-5677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20379207N00000X
WV09283207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001712123OtherBCBS
WV2004674000Medicaid
WV2004673000Medicaid
000153677OtherBC BS
HA4074551Medicare ID - Type Unspecified
A71918Medicare UPIN