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NPI Code Detail

MEDICARE: PHILLIP K. HALL M.D.

MEDICARE: PHILLIP K. 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
1207ND0101XMOHS-Micrographic Surgery Physician35070320HOH
2207NS0135XProcedural Dermatology Physician35070320HOH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10649150OTHEROHAETNA
23109647743A18OTHEROHANTHEM BLUE SHIELD
3OC02792OTHEROHNATIONWIDE
40300288OTHEROHUNITED HEALTH CARE

General Provider Information

NPI Number : 1144248493
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHILLIP K. HALL M.D.
Provider Business Mailing Address
First Line : 10727 FALLS CREEK LN
Second Line :
City : CENTERVILLE
State : OH
Zip : 45458-6063
Country : US
Telephone Number : 937-885-4310
Fax Number :
Provider Business Practice Location Address
First Line : 5300 FAR HILLS AVE.
Second Line :
City : DAYTON
State : OH
Zip : 45429-2347
Country : US
Telephone Number : 937-433-7536
Fax Number : 937-433-9612
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2006
Last Update Date : 08/03/2016

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Directions to “ PHILLIP K. HALL M.D.” Practice Location

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