Healthcare Provider Details

I. General information

NPI: 1083677736
Provider Name (Legal Business Name): MOLLY J HALL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 12/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 PHILADELPHIA DR SUITE 4505
DAYTON OH
45406-1813
US

IV. Provider business mailing address

1 WYOMING ST
DAYTON OH
45409-2722
US

V. Phone/Fax

Practice location:
  • Phone: 937-734-4363
  • Fax: 937-734-4181
Mailing address:
  • Phone: 937-208-8305
  • Fax: 937-208-6286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35 064150
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: