=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841402534
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HALL & HALL DERMATOLOGY ASSOCIATES PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 DRUMMOND STREET
-----------------------------------------------------
City | MORGANTOWN
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26505-3320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-599-5672
-----------------------------------------------------
Fax | 304-599-5677
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 DRUMMOND STREET
-----------------------------------------------------
City | MORGANTOWN
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26505-3320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-599-5672
-----------------------------------------------------
Fax | 304-599-5677
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE MANAGER PARTNER
-----------------------------------------------------
Name | WILLIAM LLOYD HALL
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 304-599-5672
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | 20379
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | 09283
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------