Healthcare Provider Details

I. General information

NPI: 1063539260
Provider Name (Legal Business Name): GREGORY L. HALL M.D. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 03/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

464 RICHMOND RD SUITE 201
RICHMOND HEIGHTS OH
44143-2704
US

IV. Provider business mailing address

464 RICHMOND RD SUITE 201
RICHMOND HEIGHTS OH
44143-2704
US

V. Phone/Fax

Practice location:
  • Phone: 216-881-5055
  • Fax: 216-999-7758
Mailing address:
  • Phone: 216-881-5055
  • Fax: 216-999-7758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number35063967
License Number StateOH

VIII. Authorized Official

Name: DR. GREGORY L HALL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 216-881-5055