Healthcare Provider Details

I. General information

NPI: 1386625572
Provider Name (Legal Business Name): JOHN W. HALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 04/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 SPRING ST 1ST FLOOR
SCARBOROUGH ME
04074-8926
US

IV. Provider business mailing address

190 RIVERSIDE ST SUITE 6B
PORTLAND ME
04103-1073
US

V. Phone/Fax

Practice location:
  • Phone: 207-885-0011
  • Fax: 207-885-5851
Mailing address:
  • Phone: 207-661-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number016009
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: