Healthcare Provider Details

I. General information

NPI: 1962714022
Provider Name (Legal Business Name): TRICIA ERICA HALL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2010
Last Update Date: 01/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 HAYNES ST STE D
MANCHESTER CT
06040-4139
US

IV. Provider business mailing address

29 HAYNES ST STE D
MANCHESTER CT
06040-4139
US

V. Phone/Fax

Practice location:
  • Phone: 860-533-4678
  • Fax: 860-533-0607
Mailing address:
  • Phone: 860-533-4678
  • Fax: 860-648-0607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number054551
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number054551
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: