MEDICARE: WILEY R 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	2084A2900X	Neurocritical Care Physician	225655	MA
2	2084N0400X	Neurology Physician	225655	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275516296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILEY R HALL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 415348
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02241-5348
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 LAKE AVE N
Second Line	:	DEPARTMENT OF NEUROLOGY
City	:	WORCESTER
State	:	MA
Zip	:	01655-0002
Country	:	US
Telephone Number	:	508-856-2527
Fax Number	:

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

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	03/07/2022

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Directions to “ WILEY R HALL M.D.” Practice Location

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