Provider Demographics
NPI:1871693077
Name:HALL, MICHAEL D (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
Last Name:HALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 7000
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26507-7000
Mailing Address - Country:US
Mailing Address - Phone:304-347-1290
Mailing Address - Fax:304-347-1397
Practice Address - Street 1:1201 WASHINGTON ST E
Practice Address - Street 2:SUITE 208
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1834
Practice Address - Country:US
Practice Address - Phone:304-388-7270
Practice Address - Fax:304-388-7280
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2022-04-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV13944208600000X
KYTP100208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0124498000Medicaid
WV0124498000Medicaid
E71794Medicare UPIN