Healthcare Provider Details

I. General information

NPI: 1912987413
Provider Name (Legal Business Name): JASON HALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 08/26/2020
Certification Date: 08/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 HARRISON AVE SUITE 2100
BOSTON MA
02118
US

IV. Provider business mailing address

801 ALBANY STREET FL GROUND
BOSTON MA
02119
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-8054
  • Fax: 617-414-8055
Mailing address:
  • Phone: 617-414-5405
  • Fax: 617-414-6031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number211337
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number227619
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: