Healthcare Provider Details

I. General information

NPI: 1851395354
Provider Name (Legal Business Name): KENT N HALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 BEEKMAN STREET
PLATTSBURGH NY
12901-0259
US

IV. Provider business mailing address

PO BOX 2868
PLATTSBURGH NY
12901-0259
US

V. Phone/Fax

Practice location:
  • Phone: 518-562-7371
  • Fax:
Mailing address:
  • Phone: 518-562-7371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number262733
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: