MEDICARE: DR. PATRICIA L. HALE I MD, PHD, FACP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	172396-1	NY

General Provider Information

NPI Number	:	1063414308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICIA L. HALE I MD, PHD, FACP

Provider Business Mailing Address
First Line	:	56 PARKHURST RD
Second Line	:
City	:	GANSEVOORT
State	:	NY
Zip	:	12831-1232
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	321 BROADWAY
Second Line	:
City	:	FORT EDWARD
State	:	NY
Zip	:	12828-1233
Country	:	US
Telephone Number	:	518-747-1041
Fax Number	:	518-747-1022

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	07/08/2007

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