Healthcare Provider Details

I. General information

NPI: 1831310853
Provider Name (Legal Business Name): ROBERT HARRY HALL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 04/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 VINE ST, THIRD FLOOR
PHILADELPHIA PA
19107
US

IV. Provider business mailing address

9619 WISSINOMING ST.
PHILADELPHIA PA
19114
US

V. Phone/Fax

Practice location:
  • Phone: 215-405-2100
  • Fax: 215-405-2108
Mailing address:
  • Phone: 267-978-2119
  • Fax: 215-405-2108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberM.D054344L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD054344L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberMD054344L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: