Healthcare Provider Details

I. General information

NPI: 1083783740
Provider Name (Legal Business Name): TIMOTHY J HALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

789 CENTRAL AVE
DOVER NH
03820-2526
US

IV. Provider business mailing address

15 HOSPITAL DR
YORK ME
03909-1011
US

V. Phone/Fax

Practice location:
  • Phone: 603-609-6819
  • Fax:
Mailing address:
  • Phone: 207-351-2400
  • Fax: 207-351-2193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35194
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberEC-06-1057
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number018378
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: