Provider Demographics
NPI:1104813724
Name:HALL, TONYA EL (MD)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:EL
Last Name:HALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:105 WAWECUS ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2146
Mailing Address - Country:US
Mailing Address - Phone:860-859-9061
Mailing Address - Fax:860-889-6200
Practice Address - Street 1:105 WAWECUS ST
Practice Address - Street 2:SUITE 1
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2146
Practice Address - Country:US
Practice Address - Phone:860-859-9061
Practice Address - Fax:860-889-6200
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT041717207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT041717OtherCONNECTICARE
CTP3133205OtherOXFORD HEALTH PLAN
CT2V4058OtherHEALTHNET NE
CT3339271OtherAETNA HMO
CT7120543OtherAETNA PPO
CT010041717CT02OtherANTHEM BCBS OF CT
CT3339271OtherAETNA HMO
P00209399Medicare ID - Type UnspecifiedRAILROAD
CT2V4058OtherHEALTHNET NE