Healthcare Provider Details

I. General information

NPI: 1639150816
Provider Name (Legal Business Name): JOHN W. HALL, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 CHASE AVE
WATERVILLE ME
04901-4624
US

IV. Provider business mailing address

PO BOX 1898
WATERVILLE ME
04903-1898
US

V. Phone/Fax

Practice location:
  • Phone: 207-872-4400
  • Fax: 207-872-4621
Mailing address:
  • Phone: 207-872-4400
  • Fax: 207-872-4621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN HALL
Title or Position: OWNER
Credential: MD
Phone: 207-872-4400