MEDICARE: TONYA E.L. HALL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	041717	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	041717	OTHER	CT	CONNECTICARE
2	P3133205	OTHER	CT	OXFORD HEALTH PLAN
3	2V4058	OTHER	CT	HEALTHNET NE
4	3339271	OTHER	CT	AETNA HMO
5	7120543	OTHER	CT	AETNA PPO
6	010041717CT02	OTHER	CT	ANTHEM BCBS OF CT

General Provider Information

NPI Number	:	1104813724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONYA E.L. HALL M.D.

Provider Business Mailing Address
First Line	:	105 WAWECUS ST
Second Line	:	SUITE 1
City	:	NORWICH
State	:	CT
Zip	:	06360-2146
Country	:	US
Telephone Number	:	860-859-9061
Fax Number	:	860-889-6200

Provider Business Practice Location Address
First Line	:	105 WAWECUS ST
Second Line	:	SUITE 1
City	:	NORWICH
State	:	CT
Zip	:	06360-2146
Country	:	US
Telephone Number	:	860-859-9061
Fax Number	:	860-889-6200

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	08/15/2014

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