Healthcare Provider Details

I. General information

NPI: 1578401469
Provider Name (Legal Business Name): DERECK NEIL HALL JR. PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

577 WESTERN AVE
WESTFIELD MA
01085-2580
US

IV. Provider business mailing address

21 DIGNON RD
BILLERICA MA
01821-2146
US

V. Phone/Fax

Practice location:
  • Phone: 413-572-5300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: