Provider Demographics
NPI:1104940956
Name:HALL, ROBERT L (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:HALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 108
Mailing Address - Street 2:
Mailing Address - City:COMMERCIAL POINT
Mailing Address - State:OH
Mailing Address - Zip Code:43116-0108
Mailing Address - Country:US
Mailing Address - Phone:614-214-6671
Mailing Address - Fax:
Practice Address - Street 1:11 JOHN LLOYD EVANS MEMORIAL DR STE 400
Practice Address - Street 2:
Practice Address - City:NELSONVILLE
Practice Address - State:OH
Practice Address - Zip Code:45764-2523
Practice Address - Country:US
Practice Address - Phone:614-599-1826
Practice Address - Fax:614-416-0345
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35085094208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2766407Medicaid
H290930OtherMEDICARE
OH2766407Medicaid