Provider Demographics
NPI:1215956867
Name:HALL, ELIOT R (MD)
Entity type:Individual
Prefix:
First Name:ELIOT
Middle Name:R
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 710
Mailing Address - Street 2:SPRINGFIELD MEDICAL CARE SYSTEMS INC.
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05156-0710
Mailing Address - Country:US
Mailing Address - Phone:802-463-9551
Mailing Address - Fax:
Practice Address - Street 1:1 HOSPITAL CT
Practice Address - Street 2:SPRINGFIELD MEDICAL CARE SYSTEMS INC
Practice Address - City:BELLOWS FALLS
Practice Address - State:VT
Practice Address - Zip Code:05101-1489
Practice Address - Country:US
Practice Address - Phone:802-463-9551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0009909208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN2069Medicaid
VTOVN2069Medicaid
VTG05132Medicare UPIN