Provider Demographics
NPI:1063539260
Name:GREGORY L. HALL M.D. INC
Entity type:Organization
Organization Name:GREGORY L. HALL M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-881-5055
Mailing Address - Street 1:464 RICHMOND RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-2704
Mailing Address - Country:US
Mailing Address - Phone:216-881-5055
Mailing Address - Fax:216-999-7758
Practice Address - Street 1:464 RICHMOND RD
Practice Address - Street 2:SUITE 201
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44143-2704
Practice Address - Country:US
Practice Address - Phone:216-881-5055
Practice Address - Fax:216-999-7758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35063967305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2920307Medicaid
OHHA0729813Medicare ID - Type Unspecified
OH2920307Medicaid