Provider Demographics
NPI:1023105897
Name:JOHN H HALL JR MD PA
Entity type:Organization
Organization Name:JOHN H HALL JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:HALL
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:336-333-9111
Mailing Address - Street 1:1305 W WENDOVER AVENUE
Mailing Address - Street 2:STE D
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408
Mailing Address - Country:US
Mailing Address - Phone:336-333-9111
Mailing Address - Fax:336-333-2042
Practice Address - Street 1:1305 W WENDOVER AVENUE
Practice Address - Street 2:STE D
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408
Practice Address - Country:US
Practice Address - Phone:336-333-9111
Practice Address - Fax:336-333-2042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DA2553OtherRR MEDICARE
NC89014WKMedicaid
NC014WKOtherBC BS NC
NC014WKOtherBC BS NC